One of the great mysteries in medical care has nothing to do with the function of the human body, the way medicines are discovered, or the secret to longevity.
The question that has defied answering for as long as I can remember is simply this:
How much does it cost?
On Jan. 1, the federal Centers for Medicare & Medicaid Services started requiring that all inpatient hospitals and long-term care facilities post their prices online in a machine-readable format, meaning it can be easily processed by computers. This previously hidden data is referred to as the “chargemaster.”
Although it can be read by machines, it still can’t be understood by humans.
Over the past 20 years, many patients have asked me how much it costs for a standard office visit. Although this would depend on their insurance, copay, co-insurance, etc, I have been able to give them at least an estimate.
But if they have asked me how much it costs to be in the hospital, I have not had any idea how to answer.
Seems odd, in the era of one-click Amazon shopping, that when someone is admitted to the hospital, there is no way to know the actual cost of care before receiving it.
CMS is making a valiant attempt at improving price transparency. Kuakini Medical Center, Queens Medical Center, Straub Medical Center and Adventist Heath Castle Medical Center have all posted the required spreadsheets of charges for their different levels of care and supplies.
The intent was to allow patients to look up the prices of their care on the internet.
But unless you have an advanced degree in medical billing, it still doesn’t make sense. The first area of mystery is the listing of abbreviations. Even though I am in the medical profession, it’s still hard to decipher the meaning behind some of the shorthand references for procedures. ABLATION LIVER CYST,PERC INJ SCLR SOL US-TECH doesn’t sound like something I would want to have done, but at least the cost is listed: $7,240.
Most patients would not recognize the shorthand or know if their intended procedure is the same as what’s listed. There are also numerical codes tied to procedures, but I would not know what code to suggest someone look up if they were trying to comparison-shop.
And hospital charges for procedures cannot be certain in advance, since no one can expect a patient to know how many bandages will be used, or sutures placed in the operating room.
Another part of the mystery is that each hospital has a different contractual rate with every insurer. What the Hawaii Medical Service Association agrees to pay for a particular procedure is always different than the chargemaster. That’s the reason contracts are signed, to provide some type of guaranteed payment amount for the services that are rendered. This is often based on a percentage higher than the standard Medicare rate for reimbursement.
Each insurer has its own proprietary contract that is not accessible to the public, nor to competitors.
High listed prices also allow for a greater dollar amount of care that is then “written off” for those who are uninsured.
Having a list of charges that isn’t based in reality leaves patients in the dark.
Comparison-shopping isn’t likely to happen when someone needs emergency surgery. Even for elective surgeries, if a trusted physician operates at only one of the facilities, knowing that the price might be less somewhere else isn’t going to make a difference.
Although the price transparency rules are a step in the right direction, this has not achieved the goal of helping the public to understand the cost of their care. In fact, the mandated machine-readable format has led to this being incompatible with human understanding.
My only answer when a patient asks me how much it will cost for their hospital stay is to offer this range: from zero to their out-of-pocket yearly maximum for all of the services that are covered by their medical insurance.
CMS needs to consider the same rules that apply to their own website, www.cms.gov. Information found there has to be understandable to a prudent layperson, easy to navigate, have a search function, and most importantly a help button with a place to call or email for assistance.
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