New system to determine medical costs ‘not terribly useful’ | Business

Irina Baranova

A new federal law requires hospitals to publish costs for various medical procedures, but navigating thousands of procedures and finding a precise cost is burdensome, and has health care advocates emphasizing the importance of establishing a uniform, standardized database.

The hospital transparency rule was first implemented under former President Donald Trump’s administration on Jan. 1, 2021.

It requires hospitals to disclose their charges, cash prices, and prices negotiated with insurance plans. The reason for this is that different patients receiving routine examinations, such as colonoscopies, would often receive bills varying by thousands of dollars.

The rule was fought in court by the hospital and insurance industries.

Before it was signed into law, prices for medical procedures were considered proprietary trade secrets by the hospital and insurance industries, preventing the release of underlying contracts and individual rates, so that consumers had no way of comparing prices across hospitals and insurance companies.

While local hospitals, including Manchester Memorial, Rockville General in Vernon, and Johnson Memorial in Stafford, are technically complying with the law, being able to accurately assess the cost of services through their websites is unlikely for a layperson.

Likewise, Hartford and St. Francis hospitals also have online databases to comply with the law, but are similarly burdensome.

While some transparency websites for area hospitals are easier to navigate, comparing prices across the state’s health care systems is extremely complicated as there are unique search words for the same procedures, depending on the health care network.

Finding the cost of a procedure isn’t as simple as plugging in the name of the operation. For example, Eastern Connecticut Health Network, which is owned by California-based, for profit Prospect Medical Inc. and includes Rockville and Manchester hospitals, does not give a price when searching for hysterectomies, even though ECHN performs them.

Complicating the matter further in finding costs for various procedures is the patient’s condition at the time of the service, and their insurance policy.

“The information available is almost entirely overwhelming even for sophisticated consumers because you’re talking about a significant list of various services and many payers (insurance companies) all with different rates,” state Assistant Comptroller Josh Wojcik said. “To be frank, from an individual consumer’s perspective, in most cases, it’s not terribly useful. It varies across hospitals how they’re listing it.”

The websites for area hospitals provide different search codes and names for the same procedures, complicating the process of comparing prices.

A knee replacement cost listed on one hospital’s website may include only the operation itself, and not the cost of an anesthesiologist or subsequent necessities, such as physical therapy. So finding the actual cost of a knee replacement — from beginning to end — varies depending on which key words are searched and on which hospital’s website.

As it exists today, the system “requires more third parties to point you in the right direction,” Wojcik said, adding that it would be more beneficial if the online databases required insurers to show exactly what people will pay, baseline out-of-pocket.

“For an individual who’s just trying to pay out-of-pocket or trying to shop around, using the hospital tools is a very overwhelming process,” he said.

The online transparency portals can be so confusing that public relations officials for Trinity Health New England, the operator of Johnson Memorial and St. Francis hospitals, were unable to explain how to find prices for various procedures, and instead punted to their transparency tool expert.

David Bittner, senior vice president and chief revenue officer for Trinity Health, said while the costs of certain procedures are required by law to be published, “most hospitals look at volume” when deciding which services to post online. That’s why it would be difficult to find certain procedures not performed very often at individual hospitals, he said.

“It’s not like it’s all displayed for every procedure,” Bittner said of the websites.

He added that doctors are generally not aware of their patients’ insurance polices, and therefore wouldn’t likely guide patients through price comparisons. However, Trinity does have a support team that can be called, he said, and the website offers pricing within 24 hours for specific procedures.

Furthermore, the cost of services depends not only on insurance policies, but also whether there are complications during or after surgery, and whether a patient has comorbidities.

“It makes it difficult to line up apples-to-apples, relative to those procedures,” Bittner said. “There could be anomalies relative to overall pricing.”

Standardized baseline needed

ECHN spokeswoman Nina Kruse said that each price in that system’s transparency page must be filtered through specific insurance plans and terms in order to provide the “clearest comparison between health care costs.”

“ECHN provides easy access to our pricing information on our website,” she said in an emailed statement. “At ECHN, we are proud to share information regarding our high-quality and high-value care.”

Yet while the ECHN network offers hysterectomies, the costs were still not provided on the network’s transparency page, as of Friday.

Considering the complexity and non-uniformity of current online price transparency sites, Wojcik opined that hospitals and insurance companies would continue to hide costs as much as legally possible.

“I think there will be slow movement in that realm,” he said. “I think it’s a rational and reasonable concern that there will continue to be reluctance to share right information and contractual information. … I think it’s going to take a while for that to change and adjust.”

Having a centralized and standardized database, potentially established by the federal government providing a common baseline, could be more helpful to consumers shopping around, Wojcik said.

“That would really make a difference,” he said, but added that the current system does have “value in unique situations.”

Considering the amount of data complied by each hospital and the range of factors used to determine prices, “it’s a pretty heavy undertaking,” Bittner said. “It’s not like a hotel room, where it’s pretty standard compared to what you’re going to get.”

Bittner said that he believes transparency would be expanded as time goes on, potentially through websites that will aggregate available information into one easily consumed, centralized location.

“I do think over time those tools will continue to get enhanced,” he said. “We will continue to get better as technology improves.”

Nonetheless, Wojcik said, the new law is at least a step in the right direction as it aims to make the health care market operate similar to other marketplaces where prices are not hidden and therefore more competitive.

“The overall goal is to make the market more competitive,” he said, adding that costs of state employees’ insurance policies were also difficult to definitively determine before this law about medical transparency went into effect.

“It created this really opaque atmosphere where it’s been very challenging to know what you’re paying for, not only for an individual but even for a health plan for the state of Connecticut,” Wojcik said. “At least this puts a scenario where there can be a check on it.”

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