The region’s largest health care providers quietly complied with a new federal rule this month that requires them to post online the costs of thousands of procedures, drugs and other medical needs.
The goal, according to the leader of the Centers for Medicare and Medicaid Services, is simple: Give patients the information they need to become informed consumers. In practice, however, patients shopping for procedures in Spokane would need to download multiple spreadsheets with thousands of lines of potentially indecipherable medical billing descriptions to get an idea of what is charged at Providence, MultiCare and Kootenai Health hospitals. Even then, the picture likely won’t be complete.
Those speaking on behalf of the region’s hospitals, insurers and patients say there are other ways to get more accurate information about how much health care is going to cost, even if the intent behind the effort is noble.
“We think it’s a step in the right direction, but there’s certainly a long way to go before this information is useful to patients,” said Nancy Giunto, executive director of the nonprofit Washington Health Alliance, which represents doctors, insurers and private companies in efforts to tamp down health care costs.
Marce Edwards, executive director of corporate communications at MultiCare Health System, said “if you do come in for a joint replacement, there’s what that costs, but then there’s a lot of other things that could be added or subtracted.” Multicare owns Deaconness and Valley hospitals, along with the numerous Rockwood medical clinics.
“You may need extra blood, extra antibiotics. Maybe something is more complex than normal, or you have another health condition that requires extra care,” Edwards said.
“Listing hospital charges may help patients understand what the costs might be for certain health care services, but the information patients and consumers want most is the amount they will actually be billed or asked to pay,” said Liz DeRuyter, a spokeswoman for Providence Health and Services, in an email. “The pricing data required by Centers for Medicare and Medicaid Services will not reflect a patient’s financial liability, as that amount will depend on the complete course of treatment received and on the specific type of insurance coverage a patient has.”
Comparison shopping is difficult, if not impossible, for patients because the hospitals aren’t required under federal rules to submit their prices in any specific format. The rule also doesn’t require health care providers to post charges in a specific location on their website. The rule only requires that the prices be submitted as a spreadsheet, but each health care provider can individually determine what descriptions they’ll use and how the prices will be submitted.
That keeps users from easily comparing one provider’s costs to another. Consider insulin, the life-saving drug for diabetics: MultiCare’s list of charges includes two options for the drug, while Providence’s list at Sacred Heart splits the drug into six potential categories. Kootenai Health has an even greater number of potential charges for insulin in its pricing document, along with a price for the injection.
And even those numbers aren’t actually what a patient should expect to pay, because most are on the hook for out-of-pocket costs based on rates that are negotiated through insurers. Those that aren’t insured may also be eligible for free charity care or other discounts off what is called the “gross charge,” the number that hospitals are required to post under the new rule.
“I think it’s fine to have it available,” said Claudia Sanders, vice president of special projects for the Washington Hospital Association. “But is it also more confusing to have it available, because almost nobody will pay those full amounts? If you’re an uninsured person with a ton of money, and going out of network, maybe those have some relevance to you.”
More relevant pricing tools exist, and they’ve been initiated at the state level, said Robert Malte, a clinical associate professor of health services at the University of Washington School of Public Health and former CEO of Kirkland-based hospital system EvergreenHealth.
“I think the purpose of the CMS rule is to catch up with what a lot of states have done,” Malte said. The Washington State Hospital Association has a pricing tool that Sanders says has been available for decades, allowing users to compare the average and median costs for common procedures across multiple hospitals based on reported billing rates. But those numbers don’t include professional fees charged by individual physicians or surgeons.
A state law passed in 2014 also required the state’s Office of Financial Management to create an online database that compiles claim information from health care providers, pharmacies and dentists to estimate pricing for more than 100 common procedures. That website, Washington Health Care Compare, launched in June.
Major insurance providers in the area haven’t seen an influx of additional calls and aren’t changing their practices when it comes to informing their customers about prices for procedures. Representatives of both Premera Blue Cross and Kaiser Permanente said they’re encouraging their clients to use available online tools or contact them directly for quotes.
“Price transparency is a really complex issue that everyone’s grappling with,” said David Buchholz, medical director for provider and customer engagement at Premera. “For now, I think everyone’s doing their own thing to make sure they can serve their customers well.”
Even if the prices that are posted don’t accurately reflect what a patient will pay, and are difficult to find and decipher, their publication might push health care providers, patients and insurers to begin discussing transparency in pricing more openly, said Steve Levy, interim executive director of the Washington Patient Safety Coalition.
“The utility right now may not be there, but they’re going to get a lot of feedback on it,” Levy said. “That’s going to push us to the next step.”
The University of Washington’s Malte called the action by federal regulators “a shot across the bow.”
“I think it says, here’s a minimum standard,” he said. “And there’s more coming.”
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