As we all know, health care fees in the United States are full of pitfalls. For patients with commercial insurance, in the Manhattan district, the cost of a caesarean section ranges from under $2,000 to more than $40,000. But often, patients and families will not know the full breakdown of the charges until they receive the bill.
For years, hospitals have protected prices they negotiate with insurers, making it harder for outsiders to tell which hospital charges the most.
Last January, federal price transparency regulations went into effect, requiring hospitals to publish once-secret prices online, a situation that should have changed. But more than a year later, the vast majority of U.S. hospitals still haven't fully complied with the law. Access to the pricing information they provide often remains difficult for the average person, and a federal official confirmed that despite hundreds of hospitals being sounded as alarm bells, the government has never imposed a fine for non-compliance.
Montefiore Medical Center in New York.
From December to January, a survey of 1,000 hospitals across the United States found that only about 14 percent fully complied with price transparency rules — 12 hospitals in New York City and Long Island were included in the survey, and they were basically problematic.
The findings were published this month in a report by the PatientRightsAdvocate.org. The site is a nonprofit organization dedicated to promoting price transparency as a way to empower patients and reduce healthcare costs. The organization found that the compliance rate rose from 5.6 percent in July 2021, but remained low.
The report shows that many hospitals in New York City have complied with federal regulations to some extent, but in the end they have missed certain key information.
Cynthia Fisher, founder and chairman of PatientRightsAdvocate.org, said: "We want to enforce it widely and vigorously and start fining hospitals for non-compliance. ”
To comply with federal price transparency rules, hospitals must post a downloadable file online that lists different costs of surgery and services, according to different medicare plans, separate from health plans, and discounted "cash prices" charged to uninsured people. They should also publish consumer-friendly pricing information for 300 "available services" to facilitate patient planning ahead, either in the form of a list or as an online interactive tool for patients to enter their insurance information and assess out-of-pocket costs they might need to incur.
Earlier, critics said the federal government planned to fine hospitals $300 a day for violating price transparency rules, but that wasn't enough for them to publish their own prices. In November, the Centers for Medicare and Medicaid Services (CMS) announced that it would impose fines of up to $5,500 a day, or about $2 million a year, on hospitals with more than 30 beds.
But Patrice Martin, a spokesman for CMS, confirmed that no fines had been issued so far. As of last month, CMS had issued warning letters to 342 hospitals that did not comply with the regulations and sent requests for corrective action plans to 126 hospitals, Martin said. She did not say whether the text messages were sent to New York hospitals.
Is price transparency possible?
If hospitals comply with the law, Fisher is optimistic about what price transparency can do, calling it "a health care revolution that shifts power to consumers."
She envisions a day when anyone can easily use an app or search engine to compare the cost of an MRI test offered by each health care provider in their area under their specific insurance plan, just as people compare ticket prices when planning a trip. Currently, medical cost estimates that hospitals provide to patients in advance are not binding, but Fisher said there is no reason not to do so.
"There are a lot of tech companies trying to analyze this data, and they need all the hospitals to comply with that data in order to be able to create a fully competitive market across the U.S.," Fisher said. ”
Some health policy experts who study consumer behavior have expressed skepticism about whether such a market would exist. "Overall, we didn't find that past price transparency efforts had the effect that policymakers and others had hoped," said Dr. Ateev Mehrotra, an associate professor of health policy at Harvard Medical School who has done research on price transparency initiatives.
Merrotra notes that when price estimation tools are available, many patients either don't know about them or refuse to take advantage of them. He added that consumer behavior is also influenced by factors other than cost, such as a doctor's referral or which healthcare providers are in someone's insurance network.
Still, Merrotra said, that doesn't mean cost information is useless, because it gives people a glimpse of which hospitals have the highest prices, "embarrassing people is a very important tool because hospitals really, really care about their reputation," he added.
Unions and other organizations in New York City, including PatientRightsAdvocate.org, formed the Coalition for Affordable Hospitals in October to push local hospitals to lower prices and increase accountability. One of the alliance's members, the 32BJ SEIU union, recently removed New York-Presbyterian from its network of health programs, citing the hospital's high fees.
"Overpricing hospitals is not a phenomenon unique to the New York-Presbyterian Church," Kyle Bragg, president of 32BJ, said in an interview about the price transparency report. "We have to keep all these hospital systems compliant. There is no reason to keep this information confidential. ”
New York-Presbyterian Hospital said in a statement: "We care about everyone who walks through the doors of our hospital, whether or not they are able to pay for medical bills." We are one of the largest Medicaid providers in the state, and we have a broad financial aid policy. ”
How new York hospitals circumvented the law
Many hospitals are only partially compliant with federal transparency regulations. For example, PatientRightsAdvocate.org report found that about 85 percent of hospitals in the U.S. offer cost estimation tools but not cash discounts, and in fact sometimes patients find it cheaper to discount prices with pure cash than to cover out-of-pocket payments through insurance. While many hospitals have issued a document listing some of the rates they negotiate with insurance companies for different surgeries, most don't include enough prices, or rates for all medicare plans they accept.
According to the report, some hospitals in New York City are largely qualified, such as Mount Sinai Hospital, which does not offer cash discounted prices but includes a complete list of prices negotiated with medicare plans. Mount Sinai did not respond to reporters' requests for comment.
Other hospitals are much worse than that. According to the report, hospitals that did not disclose fees charged to insurance companies included Montefiore, Maimonides, Stony Brook Medical Center, Langone Tisch at New York University, and Winthrop at New York University.
"Maimonides actually complied with the CMS regulations," hospital spokeswoman Suzanne Tammaro said in response to questions about the report. Montifiori and NYU Langone Hospital did not respond to requests for comment.
According to the report, New York-Presbyterian/Weill Cornell Medical Center omitted some health plan rates but provided other list of fees.
"New York-Presbyterian Hospital has been committed from the beginning to complying with the rules of hospital price transparency," said Angela Karafazli, a spokeswoman for the hospital. "As the rules are clarified, we remain committed to continually improving and updating the information we disclose for the benefit of our patients."
The report said three hospitals had irregularities in different areas: North Shore University Hospital, Long Island Jewish Medical Center and Lenox Hill Hospital.
However, even though pricing information is available, it's not always great to use. So far, negotiated insurance rates that have been published online are often included in individual documents buried on hospital websites that are difficult for the average person to detect. Many hospitals opt for .json files, which are great for computer encoding, but must be converted to a different format and cleaned up for viewing in spreadsheets.
While CMS allows for this approach, it means that researchers, employers, and others interested in the data may need a team of engineers to sort it out.
Similar price transparency regulations for insurers will take effect in July, which could give consumers more information when choosing a medical plan. Fisher is also optimistic about this measure.
"When all this information comes to light, employers, unions and every worker can choose their plan, not just based on benefit aggregation, but also price aggregation," Fisher said. ”
Source: New York Chinese Information Network
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