Meg Wingerter, The Denver Post
Most Colorado hospitals are at least partially complying with rules meant to make it easier for patients to shop for care, but even if people find and use all the price tools available, there’s still a chance they won’t know what they’re paying until they get a bill.
Colorado passed a law requiring hospitals to post self-pay prices for their most common procedures in 2017. Two years later, the Centers for Medicare and Medicaid Services mandated that hospitals post their chargemasters — essentially, a list of “sticker prices” for almost anything they offer, from procedures to the daily rate for a room.
Now, hospitals also have to post the rates they’ve negotiated with insurance companies and whatever discounts they offer to uninsured people, as well as the estimated cost for “shoppable” services.
The Denver Post surveyed the websites of 87 Colorado hospitals to find out whether they were posting price information as required by the state and the federal Centers for Medicare and Medicaid Services. Of those, 34 hospitals posted all required prices, 34 posted only the sticker price, two posted no prices, and the rest posted some subset of the required information.
That’s better than the rate some nationwide studies have found. The nonprofit group Patient Rights Advocate randomly sampled 500 of the roughly 6,000 hospitals nationwide that are subject to the rule, and found only 28 included complete information. The most common problem was leaving off at least some prices, such as the rates they negotiated with insurance plans or the cash price charged to uninsured patients.
It’s possible the difference comes from the group of hospitals examined, not from any inherent tendency to follow the rules in Colorado. Nationwide studies have focused on large medical centers and hospital systems, but The Post’s analysis included both small and large hospitals. The majority of the hospitals posting all prices in Colorado were independent, and many of them were small, rural facilities.
Julie Lonborg, senior vice president at the Colorado Hospital Association, said posting all that information quickly is difficult, particularly since hospitals have diverted much of their tech talent to handle required COVID-19 reporting. There also are lingering questions about what counts as sufficiently “consumer-friendly” language, and whether posting the information required for the federal mandates will satisfy state law, she said.
“I think that we need to allow time for everyone, post-COVID, to catch up,” she said. “If we hadn’t been doing this on top of a global pandemic, we might be a little bit further.”
Lincoln Health, which includes a 15-bed hospital in Hugo, was one of the 34 hospitals that posted all required prices. Spokeswoman Megan Mosher said they contracted with a company that sells transparency tools to ensure they were in compliance, but the expense and time to maintain it might be better spent elsewhere. Few patients use the tools, and they can get more relevant information by calling, she said.
“Our patient financial counselor is able to provide complete, accurate and comprehensive price estimates to our patients, resulting in better education and financial preparedness from our patients, which is what transparency should really be about,” she said.
Hospitals that don’t comply with the federal requirements can be fined a maximum of $300 per day, but the federal Centers for Medicare and Medicaid Services has proposed increasing that to $5,500 per day for the largest hospitals. Smaller hospitals would pay $10 per bed each day that they don’t comply.
Making prices public
Transparency proponents argue that forcing hospitals to post their prices will drive down health care spending by allowing people to shop around. Hospital trade groups counter that the information is essentially useless to the average person. Awareness of transparency rules is low: a poll by the Kaiser Family Foundation in May found only about 9% of people knew hospitals were required to post prices.
Making price data public is useful for making policy and holding high-priced hospitals accountable, said Adam Fox, deputy director of the Colorado Consumer Health Initiative. It also can help patients who are trying to find affordable care, but the posted prices aren’t a guarantee, he said.
“Ultimately, this increased transparency is good, but it’s not a silver bullet to lowering health care costs,” he said.
The vast majority of Colorado hospitals did comply with the requirement to post their chargemasters. Two of the 87 hospitals — Heart of the Rockies Medical Center and Telluride Regional Medical Center — appear to have not posted one, though Heart of the Rockies did have a tool allowing patients to look up prices. Sedgwick County Health Center has a file posted, but it didn’t contain any information when downloaded, suggesting a technical problem.
The requirement that hospitals post their chargemasters was a “helpful first step,” but it only allows for general comparisons of which hospitals are more or less expensive, Fox said. The base prices are largely theoretical, since private insurers pay lower rates, and most hospitals have discounts for people paying out-of-pocket.
In 2019, federal regulators announced they would also require hospitals to list what they charge the different insurance plans they accept, and the prices they charge people paying out-of-pocket. They also required a list of 300 “shoppable” services — scheduled procedures that allow for price comparisons.
The American Hospital Association sued to block the new rules and lost. In April, the U.S. Department of Health and Human Services started sending warning letters to hospitals that hadn’t posted all the required information, but two studies in June found significant numbers still had incomplete data on their websites. Federal regulators have delayed issuing any fines to give hospitals more time to adjust, but it’s not clear how long that reprieve will last.
Only three Colorado hospitals didn’t post shoppable services: Telluride Regional Medical Center, Keefe Memorial Hospital and Sedgwick County Health Center, which once again had a file posted that didn’t show any data. Community Hospital in Grand Junction didn’t post a separate file of shoppable services, but added all of the required information to its chargemaster.
Some hospitals made it easier to find shoppable services than others, though. On 17 hospital websites, someone looking for the shoppable services list had to click through five screens, sometimes starting on pages that weren’t intuitive, such as the “pay my bill” section. Hospitals that had a price-estimating tool frequently required anyone browsing to enter personal information before using it, which could discourage some people from shopping around.
Good to double check
The new requirements give people a better idea of what they might actually pay than the chargemaster does, though it still could be a good idea to double-check with the hospital and your insurance company, Fox said. What you actually pay will depend on how complex your care is, whether all your doctors are in your insurance company’s network and how large a share of the total cost your insurance plan requires you to pay out-of-pocket.
“These shouldn’t be taken as the amount that somebody will get billed,” he said.
The Colorado Department of Health Care Policy and Financing has called for changes to make prices easier to use, and to increase penalties for hospitals that don’t comply. In a letter to the Centers for Medicare and Medicaid Services, it asked federal regulators to:
- Require hospitals to give guaranteed prices, not just estimates
- Increase the minimum penalty to $300 per day, with no maximum penalty
- Order hospitals with pricing tools to allow patients to use them without entering personal information
- Require standardized tools and formats, so patients can make comparisons more easily
Colorado hospitals support price transparency, Lonborg said, but the association doesn’t believe posting more information is going to benefit patients. The best strategy is for patients to call their insurance company, then the hospital they’re considering, she said.
“It’s in everyone’s best interest for patients to know A) what their responsibility is and B) what their other options are,” she said. “These laws and these requirements were well-intended, I’m sure, but even (the Centers for Medicare and Medicaid Services) has admitted they’re not that helpful.”
Ultimately, there’s no real way for patients to know what they might pay in advance, Fox said.
Even if patients look up the prices, check with their insurance companies and get estimates from a hospital’s billing department, it’s still possible they’ll pay more if a doctor is out-of-network, or if they end up needing more complex care than anticipated. Still, it can be worth having an estimate in hand, in case you have to push back against an excessive bill, he said.
“We’ve had cases where people have called ahead… and they’re quoted one thing, and when the bill arrives, it’s something quite different,” he said. “It is really hard to get a good estimate.”