Should the forthcoming sale of Manchester Memorial and Rockville General hospitals to Yale New Haven Health System be approved, patients would still face the same obstacles in determining rough cost estimates for various procedures.
A federal law introduced on Jan. 1, 2021 under former President Donald J. Trump aims to make hospital pricing more transparent by requiring them to disclose their fees for various procedures, including cash prices for uninsured individuals and with Insurance company negotiated rates.
The hospital and insurance industries unsuccessfully defended themselves against the federal law in court.
Before the law was signed, prices for medical procedures were considered by the industry to be proprietary trade secrets, preventing the disclosure of the underlying contracts and individual rates, preventing consumers from comparing prices between hospitals and insurance companies.
While Connecticut’s healthcare networks, including Yale New Haven, are technically compliant with the law, it is unlikely that a layperson could accurately estimate the cost of specific services through their websites.
Yale New Haven announced this month that it plans to purchase properties now owned by California’s Prospect Medical Holdings Inc., including the Eastern Connecticut Health Network, which operates Manchester Memorial and Rockville General Hospitals, and Waterbury Health, to get them to the winning status. What Yale will pay is still unclear.
Similar to the ECHN, patients of the Yale New Haven system cannot easily navigate the transparency section of its website without assistance.
“Often the information can be buried,” said Ted Doolittle, Connecticut state public health attorney. “In an ideal world, that would be very easy to find.”
Ideally, he said, healthcare providers would have an easy-to-use graphical interface that would allow patients to quickly gather the information they are looking for to evaluate various medical procedures.
“This really doesn’t happen at any hospital in Connecticut that I know of,” Doolittle said, adding that Yale New Haven’s website is “not user-friendly at all. It contains thousands upon thousands of codes.”
Noting that health networks in the state are doing the minimum required by law, Doolittle said the problem has more to do with the wording of the law itself.
“I don’t think any Connecticut hospitals that I’m aware of are not following the law as it’s written, and that could be an indictment of the law,” he said, adding that hospitals should invest in upgrades their online databases. “It’s really up to the hospitals to take that extra step.”
However, Doolittle found that while some states have ignored it entirely, Connecticut hospitals are at least complying with the law, he said.
“While it’s hard to find in Connecticut, while it’s not user-friendly in Connecticut, at least it’s there in Connecticut and I have to give credit to the industry to that extent,” he said.
No apples to apples comparison
Deremius Williams, vice president of payer strategy and innovation at Yale New Haven Health, said that when a procedure is scheduled, a patient can have discussions with their doctor and also contact the health care system’s customer service center for assistance in determining one get estimated cost.
Because patients have help guiding them through the process, “I think our system is pretty user-friendly for patients,” she said.
Williams noted that pre-existing medical conditions, complications before or after surgery, and insurance coverage could affect costs, so they vary from patient to patient.
“None of that on the search is absolutely cut and dry,” she said. “There are several factors surrounding patient care.”
However, both Doolittle and Assistant Comptroller Josh Wojcik argue that a universal database would be better. It wouldn’t be easy either, as prices change based on multiple factors aside from pre-existing conditions or complications, including insurance coverage, they admit.
Doolittle cited the Centers for Medicare & Medicaid Services website’s “Open Payments” section, which quickly and easily provides the names of doctors and their payments from drug companies as a transparency site that meets consumer needs. A similar nationwide database based on the Open Payments system would be best, he said.
However, Williams said that a universal system for hospital pricing would be “very complicated” and difficult to maintain accuracy as multiple companies would contribute to a merger to keep the information up to date.
“It would be difficult to boil that down to a general comparison,” she said. “I think it could actually become overwhelming for patients who are surfing.”
She noted that Yale New Haven Health had its online system up and running before the federal law went into effect and has made routine upgrades since its inception.
“We keep checking it,” Williams said.
She emphasized that the sale of hospitals in the area to Yale New Haven will not affect or determine the cost of procedures.
Still, “it’s hard to predict proactively,” she said, adding that costs “can go either way.”
Doolittle agreed that a universal online hospital price comparison system would require significant investment from healthcare providers, but is still feasible.
“It’s possible, but it’s quite hard work,” he said. “It can be done, but it has to be voluntary for the hospitals. Don’t hold your breath.”