Friday, February 11, 2022

Only 14.3% of Hospitals Compliant with Price Transparency Rules After a Year | Meanwhile The Disclosures Made Reveal Price Disparities in Magnitudes of Ten

 This story really reminds me of this quote from James Madison:  

It will be of little avail to the people, that the laws are made by men of their own choice, if the laws be so voluminous that they cannot be read, or so incoherent that they cannot be understood: if they be repealed or revised before they are promulg[at]ed, or undergo such incessant changes, that no man who knows what the law is to-day, can guess what it will be to-morrow.

From Fierce Healthcare

Six months after finding only 5.6% of hospitals were in line with major price transparency requirements, an updated analysis from found hospitals’ compliance has increased to just 14.3%—with the country’s largest health systems serving as the worst offenders.

According to the report, only 0.5% of hospitals owned by CommonSpirit Health, Ascension and HCA Healthcare met the federal requirements. For-profit HCA, the largest of the three, was found by the group to fall short across every one of its 188 hospitals. ...

According to the report, 85.7% of the 1,000 hospitals did not post a complete machine-readable file of standard charges, while 4.1% did not post any standard charges file whatsoever. Additionally, 58.6% did not clearly publish payer-specific negotiated charges while 26.2% did not publish any discounted cash prices. ...

'The lack of compliance by hospitals is about more than simply the failure to follow the legal requirements,' the group wrote. 'It is also about the failure of hospitals to provide critically needed information to consumers so they can make better health decisions. Empowered with comparative price and quality information in advance of care, consumers, including employers and unions, can improve health outcomes while lowering costs by taking advantage of the benefits of competitive market efficiencies.' 

Yes, some of this is, of course, about the myriad of byzantine requirements making it incredibly difficult for businesses to follow, but I suspect an even larger portion of this is the hospital industry's unwillingness to shine even more of a light on this, from the Los Angeles Daily News:  

Consider the wild price fluctuations at these [Los Angeles area] hospitals for just one service: a standard outpatient non-contrast brain MRI (billing CPT code 70551). The price of this treatment at Cedars-Sinai varies by approximately ten times depending on the payer, from $367 for Blue Cross Blue Shield Medicare plans to $4,043 for commercial Kaiser plans.

The price for consumers with Blue Cross HMO coverage is $2,162, nearly half Kaiser’s price. These prices do not include additional facility and physician fees that patients must pay.

Brain MRI prices also vary wildly across nearby hospitals. The price disclosures indicate patients covered by a Blue Cross HMO at Torrance Memorial pay just $127 — 17 times less than Blue Cross HMO patients pay for the same scan at Cedars-Sinai just 20 miles away.

In other words, prices can vary by more than ten times for the same service at the same hospital with different insurance coverage. And prices can vary by more than ten times for the same service at different hospitals with the same insurance. Consumers lose either way.

If you include Medicaid prices — Huntington Hospital lists the Medi-Cal Los Angeles plan price for this same brain MRI at just $39 — prices can vary by 100 times.

Pomona Valley lists a cash price for this procedure: just $450. This reasonable price begs the question: What’s the point of paying thousands of dollars in healthcare premiums every month if hospitals charge insured patients thousands of dollars more than those paying cash? The Cigna price at Pomona Valley for the same treatment: $6,500.

Standalone, cash-based MRI centers in Los Angeles offer brain MRIs for as low as $225 with no additional facility fees. This cash discount demonstrates how health industry bureaucracy and profiteering drive up prices.