OGDEN — As of Jan. 1, all hospital prices must be posted online for consumers to peruse and consider. This cost disclosure, originally part of the Affordable Care Act, is now required by the Trump administration to be electronically published.
The move toward greater transparency aims to give patients more choice and control when it comes to selecting hospitals, providers and services. But how beneficial the information can actually be depends on several variables.
“We are complying with the new CMS regulation by posting our current standard charges on our website,” Craig Bielik, spokesman for Ogden Regional Medical Center, said by email on Dec. 31, noting that information will be available under Patient Pricing within a few days.
However, insurance and individual health status play a large role in determining where patients can receive care and which services they’ll require.
“Individual health insurance coverage and available hospital discounts typically have more impact on a patient’s out-of-pocket costs,” Bielik said. “That’s why we encourage patients to utilize the resources we make available to help them better understand what their liability may be based on the specific care they will receive and their individual health plan.”
McKay-Dee Hospital, an Intermountain Healthcare facility in Ogden, is also encouraging patients to contact their insurance providers directly when attempting to calculate out-of-pocket costs.
McKay-Dee has already posted a comprehensive “ChargeMaster” spreadsheet listing current hospital, supply and pharmaceutical costs. It also offers financial aid information to uninsured and underinsured patients.
At Ogden Regional, Bielik said they “understand that the insurance claims process can be confusing for patients, so we provide financial counselors who can provide pricing estimates prior to a patient receiving care at our hospital. They can also answer billing questions.”
SelectHealth, the insurance arm of Intermountain Healthcare, has compiled a “Medical Cost Estimator” to help members gauge health care costs and plan for the future.
Jill Vicory directs member and community affairs for the Utah Hospital Association that serves 55 acute and specialty hospitals, 10 health systems or management companies, and 27 affiliated professional societies. By email Wednesday, Vicory said that UHA has partnered with the Utah Department of Health for several years to offer a consumer tool called Utah PricePoint (utpricepoint.org).
“While the information utilized on Utah PricePoint.org is based on hospital chargemasters, it is designed for comparison rather than just a listing of charges,” Vicory said by email, adding that “the new CMS rule provides a standardized starting point on hospital charges, but on its own will not provide much benefit to consumers as their actual cost will be determined by a number of factors, including the specifics of their insurance coverage.”
Vicory cautioned that no silver bullet exists to alter the current trajectory of America’s rising healthcare costs.
“It will take a combination of factors to make a difference. Changes in payment models and decreased utilization of healthcare services will be significant,” Vicory said. “Transparency and patient engagement, as well as the increased ‘consumerism’ of health care are other important factors.”
Courtney Bullard, education and collaborations director for the nonprofit Utah Health Policy Project, applauded the move toward greater transparency, but also believes more must be done to contain health care costs.
“We like that the federal government is trying to empower consumers and give them more control over their hospital experience. But we feel that hospital and price transparency are the tip of the iceberg,” Bullard said. “Pharmaceutical pricing also needs to be transparent, and I don’t think (drug) prices are going to drastically change until we have more of that.”
Bullard also pointed to the many hospital visits that are crisis-driven: “You have to keep in mind that when you’re going to the hospital, it’s not always planned.”
One example of such emergencies is the high incidence of stroke, which affects more than 795,000 people in the U.S. each year. According to the Centers for Disease Control and Prevention, stroke is the nation’s fifth leading cause of death.
McKay-Dee’s ChargeMaster lists the cost of a 50 mg vial of Alteplase at $8,309.11. Alteplase is used to treat stroke, and according to the drug’s website, every minute counts. A 2-mg vial costs $393.39.
The cost of a bed in McKay-Dee’s intensive care unit is listed at $9,222.75.
And the hospital’s supply list includes a variety of plates, drill bits, screws, spinal rods and much more that combine to make shopping for personal care a maze of mystery.
But that’s where the missing consumer education piece seems particularly significant. And as Bullard sees it, the new rule places the onus on consumers to understand information now being posted online.
“Hopefully, along with this rule, the federal government, hospitals and consumer advocacy groups like UHPP can aim to educate consumers on how to utilize this information and digest it ... because it is really complicated,” Bullard said.
Funding for health care navigators who are trained to educate consumers about their options has been sharply cut by the current administration.
“We used to have federal navigator grant funding, and it was very helpful,” Bullard said. “Some of that navigator funding went toward outreach and education, and we unfortunately don’t get that anymore.”