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.

3 Comments

  1. I believe that the Affordable Care Act itself that require hospitals to post standard costs of services is a good thing for patients’ guidance.

    Rather,I think,the problem lies more on the highly technical & medical TERMINOLOGY used by the hospitals to itemize costs.

    Possibly a GENERAL listing in layman’s nomenclature then subdivisions in medical nomenclature would better help general public to understand how to use the information for their benefit and in the way the law was intended to be useful.

    Post a Reply
  2. While I am all for transparency, this just seemed like a disaster waiting to happen on so many sides. Thought this when I first heard it, seeing it now, as well.

    On a customer service side, having to calm people angry they didn’t get billed for exactly what the “estimated” payment should have been, people not understanding it, the people in billing having to explain why this doesn’t mean the same thing.

    Even for someone in the field, chargemasters (especially if just in machine language) can be frustrating to read.

    Post a Reply
  3. Healthcare has its own language and part of that language is the way CDM files are constructed. Depending on the file format used internally, the related CPT-based narrative descriptions have to be reduced to some abbreviated semblance of the full narrative description to fit into the allotted file space. There is no requirement for facilities to “unabbreviate” so the pricing information is going to look exactly as it does in the CDM file. Mechanics, Maintenance Engineers and computer techs do not translate their language into layman’s terms and I don’t believe there should be a requirement for facilities to do that. There are ways to translate the information for those wishing to do so. The only way out of this is to go back to a world where hospitals and physicians were prohibited from advertising their services and essentially operate under their own rules as opposed to broad legislation. The public has the information, someone should figure out how to translate it for them without the translation becoming another burdensome regulation. Healthcare regulatory issues have become as difficult to understand as the US Tax Code and even the tax attorneys will tell you they don’t understand all of it.

    Post a Reply

Trackbacks/Pingbacks

  1. 米国、オンライン上で入院費用等の公開義務づけ、早速問題山積 – 九州医事研究会ニュース - […] Hospitals Post Chargemaster Prices to Meet Federal Requirements, Baffling Patients | Journal of AHIMA https://ahima.wpengine.com/2019/01/18/hospitals-post-chargemaster-prices-to-meet-federal-requirements-… […]

Leave a Reply to Karen M Karban Cancel reply

Your email address will not be published. Required fields are marked *

Share This

Share This

Share this post with your friends!