The Public Health Act was enacted as part of the Affordable Care Act, which requires hospitals to make a public list of the hospital’s standard charges starting this year, but the posted price doesn’t tell the full story. Insurance, a person’s health, and the negotiated rate between insurers and providers complicates the out-of-pocket payment, the posted prices might not mean much to the average consumer.
President and CEO of the DFW Hospital Council W. Stephen Love says the council’s member hospitals support transparency, but warn to proceed with caution. “We support transparency and want people to make informed decisions,” he says. “But it is very complex, and the healthcare billing process is extremely complicated. There are different rates for different insurance plans. Medicare pays a certain rate; Medicaid, Aetna, and Blue Cross Blue Shield all pay different rates.”
“It’s good to have a transparent starting point so people can make good informed decisions,” Love says. “Overall, providers support transparency and want to do right by people. But it is very complicated, and we may need to work with you so you make a good decision.”
But if patients wanted to attempt to shop around for prices, they need to be able to find where the hospitals are posting said information. The prices have to be “machine-readable,” which means easily inputed into a computer program, but that sometimes means it isn’t particularly useful for the lay person to understand the document. While some places had detailed descriptions, most of the prices read as vague medical terms that the average consumer would be hard-pressed to understand.In the hospital world, this list of procedures and prices is called the “Chargemaster.”
At Baylor Scott and White, there is an “Estimate Your Cost of Care” page, where they advise patients to input their hospital code, insurance information, hospital status, and personal information for the policyholder to determine a better estimate. Even then, the site warns, “Many factors may influence the actual amount you will be billed, including changes to the services actually performed and updates in your coverage not reflected at the time estimates were provided.”
Below that, there is a “Cost of Services” section where patients can choose a Baylor location and download a list of prices. The Excel document that downloads has another warning about the prices listed not representing actual out-of pocket costs, and includes a list of charge codes, descriptions, and prices. The descriptions often repeat, and can be a bit difficult to interpret. For example, there are five different codes for “(OT) Eval High Complexity” with different charge codes and prices. There are over 22,000 different charge codes listed on the document.
At Medical City in Dallas, there is a page called “Pricing Estimates and Information – Uninsured Patients” that has a list of inpatient and outpatient services, with a brief description, price, and length of hospital stay. They read things like, “CARDIOLOGY – Congestive Heart Failure:An inability of the heart to circulate blood effectively enough to meet the body’s needs,” and provide a bit more detail, but there aren’t nearly as many services and procedures listed.
They also offer a detailed price list, which is another Excel document with over 38,000 charge codes, with descriptions like “ONC SEMI-PVT” and prices listed as well.
At Texas Health, their “Estimated Hospital Costs” page allows users to select their Texas Health location and download a list of prices for different treatments. There are 15 pages of procedures for the Texas Health Dallas location, with detailed descriptions such as “Incision and drainage of abscess, simple or single” with the price.
At Parkland their “Price Transparency” page, there is a link to a complete list of standard charges, which takes patients to a list with over 20,000 charge codes with brief descriptions. There are over 50 charge codes for “Sterile Supplies – Stent,” for example.
Over at Methodist, there is a more user-friendly page for estimating cost that includes the prices for the top 10 inpatient and outpatient procedures, top imaging services, as well as a downloadable chargemaster with over 11,000 different charge codes.
The price listing is a long way from the oft-predicted “retailization” of healthcare, and may cause more confusion than clarity at the moment, but Love says it is a step in the right direction. “It’s good to have a transparent starting point so people can make good informed decisions,” he says. “Overall, providers support transparency and want to do right by people. But it is very complicated, and we may need to work with you so you make a good decision.”