MEMPHIS, Tenn. — A national advocacy group found only one Mid-South hospital fully complied with new federal rules for price transparency for healthcare services.
The new federal law requires hospitals be more transparent about prices by posting the numbers in various capacities.
The lack of compliance could leave patients confused and at risk.
Jackie Tillman is a patient who could’ve benefited from the new rules. She needs a knee replacement and went to Methodist University hospital recently for imaging.
She did not know ahead of time how much the MRI was going to cost.
“I’m quite sure it was pretty high,” she said.
They billed her $2,500. She didn’t have insurance.
That led her to the conclusion that she might never have even gotten the MRI in the first place.
But in 2021, the federal government started requiring hospitals post prices in a list of “shoppable services” so patients could look up costs ahead of time and compare different facilities.
“This is a first because it puts consumers in the driver’s seat,” said Cynthia Fisher, founder of PatientRightsAdvocate.org, a group that pushes for price transparency in health care.
Her group found less than six percent of hospitals nationwide are complying with the new rules.
“That is just one small part of the very beginning of this data being unleased so all of us will be able to shop for healthcare like we do for airlines,” she said.
She referenced travel-shopping sites like Priceline and Kayak that show the future potential of healthcare price shopping. As part of the new rule, hospitals must post computer-readable files like this that show prices for all hospital standard charges.
But until these sites exist, consumers must rely on the hospital systems to search for themselves; there are 70 “shoppable services” as defined by the federal government, like MRIs, blood tests and labor and delivery. Hospitals are supposed to post those so any patient can check their charge. But most hospitals say they’re complying by offering “price estimator tools” that are often hard to use.
Price Estimator Tools
For those who have insurance, you often have to put in personal information like your name, birthday and policy number to get an estimate.
That goes against the law and helps hospitals collect data, Fisher said.
“They’re not able to see how their insurance plan compares in price to every other insurance plan covered in that hospital. So it does create more shadows and it’s collecting a lot of data on patients,” she said.
Instead, she said the information should be laid out plainly for patients to compare all plans.
Her group found only one Mid-South hospital, Baptist Collierville, complied fully with the new regulations.
“What they did differently than non-compliant hospitals is they posted all their prices: discounted cash prices as well as all negotiated rates by each payer and each plan,” Fisher said.
The Tools and How they Work
Methodist Price Estimator asks you to choose your hospital, enter whether you have insurance, date of service and then provide the exact code or procedure name. We initially found this difficult to use, as we couldn’t find some procedures, such as labor and delivery. Since then, Methodist says they have updated and improved their price estimator.
St. Francis Price Estimator asks you to enter whether you have insurance. If so, it asks for your personal insurance information and will not let you proceed without it. If you don’t have insurance, the tool is user-friendly to navigate and provides a very broad cost estimate. For example, for a “normal baby delivery,” it gave an average of $21,000, with a minimum of $4,000 and maximum of $52,000.
Regional One Price Estimator provides a spreadsheet of cost estimates by procedure for every health insurance company. If you do not have insurance, navigate to your procedure category and then go to the bottom to select “self-pay/uninsured.”
Baptist “Estimate My Costs” includes a generalized expense navigator and a patient estimator, which requires more personal information. The tools provide detailed information for patients who have insurance and those who do not. The expense navigator does not require personal information. The tools give slightly different estimates for similar services.
An Example
Jackie Tillman got a knee MRI at Methodist University Hospital. In her case, she did not have insurance. We tested the hospital’s price navigator tool to determine how much they would charge her today. To use the tool, you have to know the category of the service you’re looking for and then the exact code or name, which can be tricky for the average patient; there are around 60 types of MRIs listed. None of them listed being for the “knee.” A healthcare provider might know the true name of a knee MRI, but the average person would have to make an educated guess. We picked “MRI of the lower extremity without dye” for the left side and got Tillman’s estimate of nearly $5,000.
To compare, we did the same process in each of Baptist’s navigator tools. For a patient without insurance, one of the tools estimated it would cost $732, while the other estimated it would cost a little less than $700.
When we asked Methodist officials about the high estimate, a spokesperson told us we’d helped them identify a glitch in the system where it was not showing discounted prices for uninsured patients. Methodist said the tool has been updated to reflect the lower amount if patients pay in cash.
What’s Next?
“Get rid of the price estimator tools. They’re not real prices. Make every hospital notify all of us before we get care what the price is for our care,” Fisher said.
In a statement to WREG, the Centers for Medicare and Medicaid Services acknowledged this problem and said they’re stepping up enforcement of the new policy by increasing fines to reach a potential $2 million a year for hospitals.
WREG asked the Baptist, Methodist, St. Francis and Regional One hospital systems for interviews on this topic but all four turned down our request and referred us to their websites.
Methodist issued the following statement to WREG:
At Methodist Le Bonheur Healthcare, our mission of providing cost-efficient, high-quality care to each of our patients extends beyond medical treatment to being fully transparent regarding patient costs. Our gross charges are posted online along with our financial assistance policy. Patients are also encouraged to utilize our online price estimator for an accurate estimate of their financial responsibility for desired medical services. We encourage patients who may need assistance with their medical bills to reach out to our Patient Financial Services team at 901-542-5327 or 901-842-1255.
Baptist issued the following statement to WREG:
Baptist supports pricing transparency and is committed to educating and advocating for our patients and providing value-based, quality care. That’s why Baptist created its pricing transparency tool, Expense Navigator, more than 14 years ago when nothing else like it existed to provide meaningful pricing information for patients. Expense Navigator helps patients understand hospital charges, their out-of-pocket costs or co-pays and payment options, including how to access Medicaid or charity care. Baptist recommends patients use our Expense Navigator tool (https://www.baptistonline.org/estimate-my-costs) or consult with our registration staff or their insurance companies for pricing information or comparison shopping. Baptist has a generous charity care program and offers additional discounts to uninsured and underinsured patients. These financial assistance policies can be found on our website, in our registration areas and on our patient statements.
As technology and federal rules change, Baptist will continue to work to advance pricing transparency for patients, which we recently demonstrated by our compliance with the federal government’s pricing transparency rules that went into effect on Jan. 1, 2021. According to MedCity News and the Washington Post, Baptist is among only 5% of hospitals nationwide to fully comply with the federal price transparency rule (https://medcitynews.com/2021/07/only-5-hospitals-are-compliant-with-price-transparency-rule-heres-how-they-did-it/). Our goal is to provide meaningful and useful information to patients, and we encourage any patient who has questions about the cost of their care to contact us directly.
