Medical bill transparency may help Toledo patients shop for care
The non-profit released findings in February, 2022, after surveying 1,000 hospitals, that showed “only 14.3 percent were complying with the transparency rule.” Out of 10 Ohio hospitals included in the report only two, MetroHealth Medical Center (Cleveland) and The Cleveland Clinic, are complying.
According to Centers for Medicare and Medicaid Services, which is part of the U.S. Department of Health and Human Services, “Starting January 1, 2021, each hospital operating in the United States will be required to provide clear, accessible pricing information online about the items and services they provide.”
It’s supposed to happen in two ways including “a comprehensive machine-readable file with all items and services,” and “a display of shoppable services in a consumer-friendly format.”
Fisher said the data would give tech companies the ability to synthesize the data across hospitals.
“Imagine when we get all the data unleashed from these hospitals, we’re going to have shopping tools much like airlines do,” she said. “Like Expedia or Kayak or Google Flights did for airlines, consumers are soon going to be able to find what is [the cost of] an MRI and if I want to get one in 48 hours where can I get one and at what price.”
PatientRightsAdvocate.org’s study found “37.9 percent of hospitals surveyed posted a sufficient amount of negotiated rates, but over half were not compliant in other criteria of the rule, such as listing rates by each insurer and named plan.”
Hospitals can be fined significantly but so far that hasn’t happened. In a written statement, a CMS spokesperson told WTOL 11, as of May, 2022, after a ‘comprehensive review,’ 352 warning notices have been issued to hospitals who were out of compliance with Hospital Price Transparency regulations.” Of those, 169 hospitals have addressed the citations. “To date, each hospital that has come under compliance review has resolved its deficiencies or is in the process of doing so. Therefore, it has not been necessary for CMS to issue any penalties.”
Bowling Green State University Assistant Professor in the Department of Public and Allied Health, Jinha Lee said eventually patients will choose hospitals that are more open with information. It could also help level the field when it comes to care.
“This transparency is the first step to make things affordable and to make health care service more common to everybody,” he said.
With the help of PatientRightsAdvocate.org, WTOL 11 was able to use the cost of one of Rostkowski’s procedures as an example.
The hospital charged $1,712 for the procedure. Her insurance paid $707.79 of that but the lowest discount cash price among a select group of hospitals in northwest Ohio was $211.50.
Fisher said price transparency is transformative. “We all need to care about prices in health care because coverage comes out of our paychecks and our wages and the only way we can bring down the cost of health insurance and get more money into our wages and earnings and to be able to protect our health by having financial certainty is to know the prices before we go,” she said.
“If you choose to be overcharged by a hospital for $3,500 for an MRI that is what then comes out of your premiums and the premiums come out of paychecks and wages because every employee shares in charges for their health benefits that otherwise would be take home pay.”
