Medical expenses remain opaque | shop

A new federal law requires hospitals to publish the costs of various medical procedures, but navigating thousands of procedures and finding accurate costs is tedious, and health care advocates stress the importance of establishing a consistent, standardized database.

The hospital transparency rule was first implemented on January 1, 2021 under the administration of former President Donald Trump.

Hospitals must disclose their fees, cash rates, and rates negotiated with insurance plans. The reason for this is that different patients who receive routine examinations, such as B. colonoscopies, often receive bills that vary by thousands of dollars.

The rule has been contested in court by the hospital and insurance industries.

Before the law was signed, prices for medical procedures were considered proprietary trade secrets by the hospital and insurance industries, preventing the underlying contracts and individual rates from being published, leaving consumers with no way to compare prices between hospitals and insurance companies .

While local hospitals, including Manchester Memorial, Rockville General in Vernon and Johnson Memorial in Stafford, technically comply with the law, a layperson is unlikely to be able to accurately estimate the cost of services through their websites.

Likewise, Hartford and St. Francis hospitals have online databases to comply with the law, but are similarly burdensome.

While some transparency websites for hospitals in the region are easier to navigate, comparing prices between state health systems is extremely complicated because there are unique search terms for the same procedures depending on the health network.

Finding the cost of a procedure isn’t as easy as entering the name of the operation. For example, the Eastern Connecticut Health Network, which is owned by California-based for-profit Prospect Medical Inc. and includes Rockville and Manchester hospitals, does not list a price when it searches for hysterectomies, even though ECHN performs them.

The condition of the patient at the time of the service and his insurance policy add to the difficulty in determining the costs for various procedures.

“The information available is almost completely overwhelming, even for experienced consumers, because you’re talking about a sizable list of different services and many payers (insurance companies), all with different rates,” Assistant Comptroller Josh Wojcik said. “To be honest, it’s not very useful from an individual consumer’s perspective in most cases. It varies from hospital to hospital how they list it.”

Area hospital websites offer different search codes and names for the same procedures, making it difficult to compare prices.

The cost of a knee replacement listed on a hospital’s website may only include the surgery itself and not the cost of an anesthesiologist or subsequent necessities such as physical therapy. So, determining the true cost of a knee replacement – ​​from start to finish – depends on what keywords are searched for and on which hospital website.

As it exists today, “the system requires more third parties to point you in the right direction,” Wojcik said, adding that it would be more beneficial if online databases required insurers to show exactly what the People will pay starting from the baseline. Bag.

“For a person just trying to pay out of pocket or look around, using the hospital tools is a very overwhelming process,” he said.

Online transparency portals can be so confusing that PR officials at Trinity Health New England, which operates Johnson Memorial and St. Francis Hospitals, couldn’t explain how to find prices for various procedures, going instead to their expert on Transparency tools stabbed.

Trinity Health senior vice president and chief revenue officer David Bittner said while the cost of certain procedures is required by law to be published, “most hospitals look at volume” when deciding which services to publish online . That’s why it’s difficult to find specific procedures that individual hospitals don’t do very often, he said.

“It’s not like every procedure shows everything,” Bittner said of the websites.

He added that physicians are generally unaware of their patients’ insurance policies, and so are unlikely to guide patients through price comparisons. However, Trinity does have a support team that can be called, he said, and the site offers pricing for certain procedures within 24 hours.

In addition, the cost of services depends not only on insurance policies, but also on whether there are any complications during or after surgery, and whether a patient has comorbidities.

“It makes it difficult to align apples to apples compared to these methods,” Bittner said. “There could be anomalies in terms of overall prices.”

Standardized baseline required

ECHN spokeswoman Nina Kruse said that each price on the transparency side of this system must be filtered through specific insurance plans and conditions to allow for the “clearest comparison between health care costs”.

“ECHN provides easy access to our pricing information on our website,” she said in an emailed statement. “At ECHN we are proud to share information about our quality and quality care.”

But while the ECHN network does offer hysterectomies, the cost has not yet been revealed on the network’s transparency page as of Friday.

Noting the complexity and inconsistency of current online price transparency sites, Wojcik said hospitals and insurance companies would continue to hide costs as much as legally possible.

“I think there will be slow movements in this area,” he said. “I think it’s a reasonable and sensible concern that there will continue to be reluctance to share legal information and contractual information. … I think it’s going to take a while for that to change and adapt.”

A centralized and standardized database, possibly set up by the federal government, that provides a common ground could be more helpful to shoppers, Wojcik said.

“That would really make a difference,” he said, but added that the current system “has value in unique situations.”

Given the amount of data that’s being compiled from each hospital and the range of factors used to determine pricing, “it’s a pretty tough proposition,” Bittner said. “It’s not like a hotel room where it’s pretty standard compared to what you’re going to get.”

Bittner said he believes transparency would increase over time, possibly through websites that aggregate available information into one easy-to-use, centralized location.

“I think these tools will continue to improve over time,” he said. “We will continue to get better as technology improves.”

Nonetheless, according to Wojcik, the new law is at least a step in the right direction as it aims to make the healthcare market function similarly to other marketplaces where prices are not hidden and therefore more competitive.

“The overriding goal is to make the market more competitive,” he said, adding that the cost of insurance for state employees would also be difficult to determine unequivocally before this medical transparency law comes into force.

“It created this really opaque atmosphere where it was very difficult to know what you’re paying for, not just for an individual, but even for a Connecticut state health plan,” Wojcik said. “At least this presents a scenario in which it can be verified.”

About Cindy Johnson

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