Health care price transparency gets off to a slow start

Written on Feb 13, 2019

As part of the fiscal year 2019 inpatient prospective payment system (IPPS) final rule, the Centers for Medicare & Medicaid Services (CMS) required hospitals to publish their lists of retail charges for individual services and DRGs in online spreadsheets starting on Jan. 1.

However, some hospitals are struggling to post their chargemaster lists, while others have posted lists that cause more confusion for patients than clarity, according to a report from HealthLeaders Media. The available lists require patients to locate and piece together the price of each component of their visit or potential visit, including items such as specific blood tests, medicines, and facility and physician charges.

Lists that are available are often hidden deep in hospitals’ websites, according to the report, which also suggested that it’s easier and faster to just Google the hospital’s name along with “billing” or “chargemaster” and find a direct link, rather than poking around a hospital’s website for hours.

Even if patients find the list and try to piece together an estimate for their care costs, the names of diagnoses, procedures, treatments, etc. are often opaque to those without a medical degree. For example, the University of California San Francisco Medical Center's chargemaster includes a $378 charge for "Arthrocentesis Aspir&/Inj Small Jt/Bursa w/o Us," which is basically draining fluid from the knee.

Even when the DRG prices are listed, there may be varying charges based on the patient’s conditions. While a medical professional may understand the thousands of dollars’ difference between two diagnosis related groups, that disparity may be confusing to patients.

On top of the confusing nature of chargemaster lists, the prices listed are rarely the ones that hospitals actually receive from insurers.

Many facilities push back against the idea of publishing the average prices they generally accept from insurers, however, saying that negotiated rates are a trade secret, according to the report.

Despite these many pitfalls, some experts still say that making the charges public shines a light on the often highly varying prices set by different facilities. And, posting the chargemaster lists represents a first step at price transparency for patients.

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