Hospitals Post Chargemaster Prices to Meet Federal Requirements, Baffling Patients

To comply with an Affordable Care Act provision and a directive from the Trump Administration, hospitals are posting prices for procedures and services listed in their chargemaster in the name of price transparency. However, in complying with the letter of the law, the information is virtually unreadable to patients and leaves advocates and stakeholders questioning the wisdom of the requirement.

The requirement, as written in the original Affordable Care Act, states: “Each hospital operating within the United States shall for each year establish (and update) and make public (in accordance with guidelines developed by the secretary) a list of the hospital’s standard charges for items and services provided by the hospital.”

However, as interpreted by the Centers for Medicare and Medicaid Services (CMS), hospitals are only required to post pricing information on the Internet in a machine-readable format, according to the New York Times. This has resulted in hospitals, such as Baptist Health in Miami, FL, listing charges and prices as such: “Embolza Protect 5.5 costs $9,818” while a “Visceral selective angio rad costs $5,538.” Vanderbilt University Medical Center listed a cardiac procedure, “HC PTC CLOS PAT DUCT ART” at a price listed at $42,569.

As consumer health advocates note the terminology used, while machine-readable, doesn’t help consumers find procedures written in terms they would use, and the prices in no way reflect what a patient on Medicare or commercial insurance would actually pay. While consumers with high-deductible plans could pay a sum close to the listed price, they could be irrelevant to other consumers. Additionally, the law only requires hospitals to post prices on their websites; some have responded by putting a link to chargemaster prices on their homepages while others have buried them on pages much harder to find.

On Twitter, Niall Brennan, former CMS official and president of the Health Care Cost Institute, notes that CMS has published comprehensive data sets of hospital charges annually since 2013.

“So I’m pretty unimpressed with this latest initiative and think we continue to keep asking ourselves why we continue to roll our terribly flawed “transparency” initiatives that do little or nothing to help patients navigate the system in a more informed manner,” Brennan wrote in a Tweet.

“For patients to know up front how much their care will cost, that’s incredibly valuable,” Brenda L. Reetz, the chief executive of Greene County General Hospital in rural southwest Indiana, told the New York Times. “We’ve posted our prices, as required. But I really don’t think the information is what the consumer is actually wanting to see.”

Mary Butler is the associate editor at Journal of AHIMA.

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