More than two years after federal price-transparency requirements took effect, just 40% of Illinois hospitals studied by a Boston-area nonprofit watchdog group were listed as complying with the rules.
Patient Rights Advocate in its most recent semi-annual report noted that 45 out of 75 hospitals in the state haven’t met the standards, including OSF Saint Francis Medical Center in Peoria and five Carle hospitals, including Methodist and Proctor in Peoria and Pekin Hospital. (Carle’s Eureka Hospital was not listed.)
Since Jan. 1, 2021, all U.S. hospitals have been required to provide clear, accessible pricing information online about the items and services they provide. Before, most hospital price data focused on surgery price and inpatient care. Hospitals now must show prices in two ways, according to the U.S. Centers for Medicare & Medicaid Services: “As a comprehensive machine-readable file with all items and services, (and) in a display of shoppable services in a consumer-friendly format.
“This information will make it easier for consumers to shop and compare prices across hospitals and estimate the cost of care before going to the hospital,” CMS says.
Knowledge is power
That’s important, adds Patient Rights Advocate (PRA).
“Imagine dining at a restaurant and you don’t get to see the prices for your food until you get multiple bills in the mail weeks or even months later, and in some cases, you may even be served food you didn’t even order or need, but still be forced to pay for when the bill arrives,” PRA says. “That is why one in five Americans have medical debt in collections and one-third of the population is in debt due to medical expenses. This is also why 64% of Americans have delayed or forgone care out of fear of surprise medical bills.
“By knowing prices, we the patients will be able to know before we go,” PRA continues, “and will not be burdened by the fear that comes with being blind to prices.”
Does OSF make the grade?
PRA’s report claims OSF “fails to provide an adequate amount of de-identified minimums, maximums, and negotiated rates.”
De-identified data has no identifying information, and hospitals must list five standard charges, PRA Director of Research Ilaria Santangelo told The Community Word:
“Gross charges, discounted prices, minimum, maximum and all negotiated prices,” she said.
OSF’s Media Relations Manager Shelli Dankoff said all OSF HealthCare hospitals comply with all applicable federal and state requirements.
“We have provided all of the standard charge data elements required,” she commented. “The data elements are provided in a consumer-friendly, web-based patient estimation tool and also disclosed in a comprehensive single machine-readable file.
“We fully support helping our patients understand the cost of care and the options they may have,” she added. “To that end we encourage everyone to use the web-based patient estimator tool or reach out in advance of any medical test or procedure to receive a tailored estimation specific to the individual’s situation.”
What about Carle?
PRA’s explanations of finding different Carle facilities weren’t compliant says they’ve omitted de-identified minimums, maximums, and negotiated rates, omitted gross charges, or failed to identify specific plans for all commercial payers under the Standard Charges File.
“For example, hospitals have to post negotiated prices for each payer and plan, whether a PPO or HMO or Aetna or Cigna,” Santangelo said. “And every charge, every item has a gross — like a car’s MSRP.”
Harry Croton, Media Relations Specialist for Carle Health Greater Peoria also disputed PRA’s conclusions.
“Carle Health patients have access to our standard charges and a price estimator tool in conformity with price transparency requirements,” he said. “Carle Health is committed to helping patients make informed choices about their care and meets all required steps to provide the most accurate and current information for their decision-making.”
PRA says, “Hospitals already have the data digitally and can quickly post their prices for all to see. As patients, the control over your health and wellness (physically and financially) should be in your hands, not in the hands of hospital administrators who can easily provide information to empower patients, but have chosen not to.”
What do they say about PRA?
The American Hospital Association trade group criticized PRA.
“The AHA continues to be disappointed with inaccurate portrayals of hospital compliance that do not line up with the assessment of regulators and only serve to confuse and distract policymakers,” commented Molly Smith, AHA’s Vice President for Policy. “Once again, Patient Rights Advocate has put out a report that blatantly misconstrues, ignores, and mischaracterizes hospitals’ compliance with federal price transparency regulations.”
However, PRA also credited hospitals it found to be meeting the requirements, such as nine Advocate medical centers in Chicagoland, four medical centers operated in central Illinois by Hospital Sisters Health Systems, and three Northwestern Hospitals in Chicago, Palos Heights and Winfield.
There’s no record of enforcement actions against Carle or OSF concerning price-transparency issues, and the Centers for Medicare & Medicaid Services has investigated and levied fines on some consumer complaints elsewhere. In the last two month, CMS has issued Civil Monetary Penalties of between $55,000 and $974,000 against seven U.S. hospitals, from Florida to New York, and metro Washington to Puerto Rico.