More than four years after raising concerns about the difficulty of discerning clear price information for hospital services, we expect Governor-elect Maura Healey to be less than happy with a recent study that indicates calculating these costs remains a confusing process.
Finding information about healthcare procedures on Massachusetts hospital websites can be a “backdoor or frustrating process,” according to a Pioneer Institute report, despite a 2019 federal law requiring hospitals to turn over all prices available online in a user-friendly format.
The conservative fiscal watchdog studied a sample of 19 Massachusetts hospitals to assess compliance with the Public Health Services Act, which went into effect in January 2021 after the federal Centers for Services passed regulations. Medicare and Medicaid. The researchers said the hospitals surveyed were “of all sizes in urban, suburban and rural areas of the state.”
In addition to finding “wide price variations for several common procedures,” the researchers determined that information on discounted cash prices – the rate a hospital would charge people who pay cash – was not available for 37% of hospitals in the study.
“Even among hospitals that display discounted spot prices, compliance rates with displaying prices for all procedures for which it is mandatory are variable,” the Pioneer Health report says. “Compliance rates ranged from a low of 60% to a high of 97%.
The researchers found price variations ranging from almost 100% for an abdominal ultrasound to more than 300% for an MRI of a leg joint. Other variations cited in the report include the price of a mammogram of both breasts, which ranged from a high of $962 at Lahey Hospital & Medical Center in Burlington to a low of $392 at South Shore Hospital in Weymouth.
“These disparities portray a market dominated by certain systems capable of keeping prices above competitive standards,” the report said. “That’s why provider price transparency is crucial information that consumers, employers, benefit managers and insurers should have easy access to.”
This has been a longstanding complaint of small, non-aligned suburban and rural hospitals, which have historically received lower reimbursements from insurers than larger Boston-based hospitals for the same procedures with similar outcomes.
The report, released Nov. 17, includes several recommendations, including the establishment of an administrator responsible for price transparency in each hospital, stronger enforcement of federal price disclosure rules, and advice from the federal government on how to to make pricing websites more consumer-friendly. -friendly.
At the state level, the report suggests creating incentives to improve hospital compliance rates.
“The lack of information on health care prices may not be a problem for some consumers because they have good health insurance and therefore believe that price is not important,” the report said.
“This is a mistake, however, because we all directly or indirectly pay for rising healthcare costs through higher insurance premiums. In many cases, however, the lack of price transparency poses a problems due to health insurance with high deductibles or situations where consumers are underinsured or uninsured.
That last statement should strike a chord with Healey, our outgoing attorney general and future governor.
Acting as the state’s law enforcement official in October 2018, she told the Health Policy Commission that it’s “often nearly impossible” for patients to get pricing information before they go. obtain services.
This is of particular concern given the increase in enrollment in high-deductible insurance plans.
Like the Pioneer Institute report, Healey at the time cited studies showing wildly disparate prices, where the same service may cost $1,000 at one hospital and $300 at another.
The complexity of the system, she says, is underscored by another study that found seven employees involved in billing activities for 10 physicians.
Healey informed the HPC that reducing the financial and administrative complexity of healthcare and increasing price transparency should be goals in the continued effort against the slow rising costs that are constantly a big concern for health care providers. individuals, families, businesses and government.
We don’t know where the problematic cost of hospital services ranks on Healey’s list of priorities when she becomes governor in January.
Obviously, given the often confusing nature of our state and nation’s health care systems, finding a workable solution to competing cost drivers will take more patience and perseverance than it has to date.
But since health care costs make up about 40 percent of the state’s annual budget, it’s a topic Healey can’t ignore.
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