COLORADO SPRINGS – In 2019 under a new federal rule, hospitals will be required to post a list of their standard patient charges online. The new federal rule is meant to make it easier for patients to see the prices of hospital procedures and care.
In March, the head of the Centers for Medicare and Medicaid Services, Seema Verma said the new requirement for online prices reflects the Trump administration’s ongoing efforts to encourage patients to become better-educated decision makers in their own care.
“We are just beginning on price transparency,” said Verma. “We know that hospitals have this information and we’re asking them to post what they have online.”
Hospitals are already required to disclose prices publicly, but this change will put that information online in a machine-readable format that can be easily processed by computers.
It may still prove to be confusing to consumers since standard rates are like list prices and don’t reflect what insurers and government programs pay.
Patients concerned about their potential out-of-pocket costs from a hospitalization would still be advised to consult with their insurance company.
Most insurance plans have an annual limit on how much patients must pay in co-pays and deductibles, although traditional Medicare does not.
In the case of online records, many health care providers already make computerized records available to patients, but starting in 2021 Medicare would base part of a hospital’s payments on how good a job they do at this task.
Here in Colorado, UCHealth is now one of the nation’s first health care systems to provide individualized price estimates that are specific to patients’ own insurance situations via its online patient portal, mobile app, and through a dedicated call center.
“UCHealth is focused on providing an excellent experience for our patients, and this includes increasing transparency in the insurance and billing process,” said UCHealth President and CEO Elizabeth Concordia. “This innovative service helps patients understand and plan for their out-of-pocket expenses for health care.”
Until now, accurate estimates have been difficult for hospitals to provide because a patient’s out-of-pocket responsibility depends on their insurance plan details as well as how much of their deductible and out-of-pocket maximum they have reached, information only the insurance company and patient have. A patient with a $5000 high-deductible insurance plan would have a dramatically different responsibility than a patient with a low deductible or someone who had already reached their out-of-pocket maximum.
UCHealth is now able to immediately connect with an insurance plan, confirm a patient’s insurance information, and even identify how much of their deductible and out-of-pocket maximum the patient has already met during their plan year. The patient then can select from multiple UCHealth locations and services to compare costs and receive an estimate. Services include MRIs, CT scans, deliveries, orthopedic surgeries, cataract removal and more.
“Businesses and insurance companies have been using high-deductible insurance plans to shift more health care costs onto consumers,” said UCHealth Chief Financial Officer Dan Rieber. “This estimates tool gives patients the power to make informed health care choices, and it also can help guide patients as they select an insurance plan that’s right for them.”
Current patients can login online to UCHealth’s My Health Connection portal or through the UCHealth mobile app to access estimates. New patients, or those without a My Health Connection account, can create an account. Estimates for additional locations and services are available by speaking with a patient estimates representative. Patients also can access other services through the mobile app and My Health Connection including accessing test results, messaging doctors, making appointments, conducting a virtual visit, refilling prescriptions and tracking other health care info.
“UCHealth has already been recognized nationally for our advanced electronic medical record and services for patients, including being named a Most Wired health care organization,” said UCHealth Chief Information Officer Steve Hess. “Patient estimates are yet another way we’re helping our patients and giving them the tools to improve their health.”
Visit UCHealth’s billing and pricing information page for more information and to view a video that helps to explain the process. Estimates for more than 150 services are available now, and more are being added regularly.
Federal regulations prevent independent providers from sharing their contracted rates with hospitals, so doctors’ professional fees are not included in the estimates.
Centura Health also operates several of our hospitals across Southern Colorado. Centura Health leaders sent me this in response to my questions about the new requirements and what their patients should know.
What can patients expect? Beginning January 1, all hospital’s standard charges will be posted online in a format that can be downloaded to computers. The list of charges will be updated every year to give patients the most current information.
How will this benefit Centura patients? While the intention of this new requirement is to allow patients to have a better grasp of how medical costs are broken down before insurance, Medicare or Medicaid, in reality the complexity of a charge master (which is a very detailed line item by line item pricing list) will not be useful for Centura patients or any health care consumer.
If patients want to understand the out-of-pocket costs for a health care procedure, they would need to know multiple insurance codes and search those in the charge master to estimate the actual cost, specific to their needs. Every procedure can be made up of hundreds of codes that are unique to the patient.
Therefore, Centura Health provides consumers and patients with two options to understand how much they will be required to pay out-of-pocket. The first is a custom estimate option and the second is a list of specific prices for common procedures that are available on our web site.
What are we looking to accomplish? Centura Health feels our existing approach towards transparency that has been available to consumers since 2014 is more specific and applicable to the patient.
Centura Health has gone above and beyond the requirements outlined in the new CMS ruling. In 2014 we began publishing specific prices for common procedures for hospital and clinic services on our website, ( https://www.centura.org/patients-and-families/pricing ). This pricing tool allows consumer and patients to search the price for specific services they are seeking. Centura Health is committed to honoring all pricing listed on our website.
Additionally, Centura Health provides consumers and patients with a custom estimate option which utilizes the patient’s specific insurance coverage (Medicare, Medicaid, commercial insurance, etc.) to determine how much a patient will be required to pay out-of-pocket. Any patient can go online or call to request a custom estimate on any procedure offered at Centura Health. The link to request a custom estimate is: https://www.centura.org/patients-and-families/pricing/request-custom-quote or they can call 1-866-224-3030.
What would we like our patients to know about the new requirement? While Centura Health will be compliant, we do not believe this new CMS requirement benefits consumers and patients as they search for the best value for their health care dollar. Over 97% of our patients never pay full billed charges for the care they receive, so the use of the charge master does not reflect how much care will cost an individual patient. In reality, the type of benefit coverage a patient has, such as Medicare, Medicaid, insurance through their employer, or individual insurance purchased on or off the Health Insurance Exchange, will be more impactful on the amount they will be asked to pay out-of-pocket.
The Associated Press and our other news affiliates also contributed to this report.