The Center for Medicare and Medicaid Services (CMS) required hospitals to post their standard charges for every item they use (also known as chargemaster prices) online from the 1st of January. Their expectation was that this price transparency would translate to patient empowerment, as it would enable patients and their caregivers to make informed choices between healthcare providers, based on the cost of the treatment required.
In full compliance of the regulatory requirements, hospitals around the US have made their chargemaster price information publicly accessible. The providers, however, have failed to give meaningful access to the costs related to patients and their treatment. Let’s delve deeper and understand why unloading data related to cost of treatment without any insight is not helpful:
- Hospitals dumped all the costs in huge lists online without throwing light on the cost of specific services. So, if someone wanted to compare the costs involved in a tonsillectomy, not only would they need to know the names of each consumable, each test, and each service but also the doctor/specialist charges that would be incurred during such a surgery.
- Some providers have posted a link to an excel sheet online, which displays massive columnized lists showing prices of more than 20,000-35000 items, making it difficult if not impossible, to verify the costs prior to availing any medical service.
- Many of these lists posted online use abbreviated names, codes, and mixed-up terminology, making it nearly impossible to understand anything from them.
- Thousands of services have been listed with minor variations and described using abbreviations and codes to reflect price variations. This makes the process even more cryptic.
- Some providers have displayed the costs using complex software which is only machine readable and defeats the purpose of a transparent policy.
The raw data that’s been dumped online is useless to the public and could even be misleading. But of course, there are always exceptions to any rule and some consumer-friendly hospitals like El Camino Hospital in Mountain View, Calif., Baylor Scott & White, Tx., among others. They have invested the time and effort needed to provide transparent online tools which enable patients to make a reliable estimate of the out-of-pocket expenses they would incur for their services. These tools factor in an individual consumer’s health plan benefits and deductible status before providing the estimate.
Currently there are no checks in place to ascertain the integrity of the data posted by providers online and no penalties for non-compliance. Therefore, it is necessary for the CMS guideline to include some checks and balances to attain true price transparency. Till then, the patients and their families will have to contend with complex documents to analyze cost differences across different care options.