As researchers, advocacy groups and employers push hospitals to reveal their prices, the industry continues to cover up what it considers trade secrets.
Now – in violation of federal rules demanding hospitals made those figures public six months ago – the University of Kansas, Olathe Health and Children’s Mercy hospital systems still do not release them.
They are joined by perhaps thousands of hospitals nationwide and scores in Kansas that have not budged since a Trump administration decision took effect on January 1st forcing them to reveal prices they have long kept under surveillance.
“We missed the deadline. … I guess that makes us in violation, ”a KU Health System spokesperson wrote in an email. “We are working on it.”
Other hospitals have made similar comments or said they have launched interactive web tools that allow patients to get price quotes for certain services, such as childbirth.
These user-friendly formats – such as this one of the KU Health System – for “purchasable” services are part of the same federal rule. But since it is effectively impossible for researchers, employers and health plans to use the tools to study broader price trends, hospitals must also publish their prices in machine-readable files which often contain several thousand dollars. data lines.
“We do not yet have a date set” for the publication, said another hospital system. The Mercy Hospital System, not to be confused with Children’s Mercy, operates facilities including the one in Columbus, in southeastern Kansas.
One hospital system, Olathe Health, argued that launching its pricing tool and publishing a gross fee spreadsheet was enough to meet the rule. But the federal government says the opposite.
Hospitals fought the Trump administration rule and tried to block it in federal court, but failed. Now hospitals appear willing to risk nominal fines rather than stock prices in a format that experts say could help cut costs.
The industry claims the numbers could confuse patients about the prices they will ultimately pay, as insurers often take part of the bill. They also say that the billing calculations are extremely complex, not easy to publish, and that the revelation of prices could give insurance companies unfair leverage in future negotiations.
“Our concerns include that the transparency file does not reflect what a patient is actually paying,” KU Health System said.
But the publication prices en masse could arm communities with solid numbers to push for better healthcare deals. Thousands of people in one county in Colorado have done just that, banding together to negotiate new prices at a local hospital and save about $ 2 million last year.
Transparency could also settle disputes over which hospitals offer reasonable prices.
Last year, employers handed hundreds of KU hospital bills to RAND Corp. as part of a major effort to compare prices nationwide. The think tank’s findings suggest that KU Hospital is one of the most expensive in the country. The KU health system at variance.
How many hospitals are not compliant?
It is not known exactly how many hospitals have published their prices.
Last month, researchers from University of Minnesota and Harvard University each published studies that involved checking hundreds of hospitals. Their results both suggest that a quarter or less of the country’s hospitals had published everything they owed.
Many more had created these interactive web tools. For Suhas Gondi – a medical and business graduate student and lead author of the Harvard study – this illustrates the resistance of hospitals.
“They’re okay with investing the money to build a price estimator,” Gondi said, “But they’re not okay with just releasing the spreadsheet.”
Even among those who published the spreadsheets, the the Wall Street newspaper found hundreds of hospitals using html code to prevent price lists from appearing in Google searches.
Earlier this year, a California-based data collection company Turquoise Health set out to put together the machine-readable files from every hospital in the country. This colossal task requires going through thousands of web pages month after month to see if more installations have complied.
“It’s important that people finally have access to this data,” said Marcus Dorstel, COO of Turquoise. “You could save a few thousand dollars by walking 10 miles down the street for your MRI.”
Turquoise’s latest tally: About half of hospitals across the country have posted prices, but nearly a third haven’t released everything federal rules say they should. According to Turquoise, only a quarter of Kansas hospitals have hit the mark. The company continues to review newly released files.
Some hospitals only publish partial information, not the full picture. The federal rule requires not only the gross prices that do not apply to most patients, but also the cash rebates and prices specific to each health plan to be made public.
After that ?
No one knows how long it might take for all hospitals to comply.
The federal government has sent warning letters to some facilities, Fierce health care reported, but observers remain skeptical that the U.S. Centers for Medicare & Medicaid Services have the bandwidth to enforce the rule broadly, and they don’t think the potential fine of $ 300 per day in case of violation generates a lot of urgency.
It “comes to nothing” for many hospitals, Gondi said.
Given that the American Hospital Association fought the rule in court last year, it’s possible some thought the rule would never take effect.
“Many in the industry were hopeful that this would not come to pass,” said Jean Abraham, author of the University of Minnesota study. “But it did.”
Abraham, professor of health care administration, was a senior economist at the Council of Economic Advisers under the Obama administration. She worked on the Affordable Care Act.
One thing the law has failed to do was slow the rising costs of care, she said. The transparency rule could shed light on the wide variations in the prices people pay for the same services. Whether that ends up driving prices down could vary depending on the market, but Abraham said it was worth a try.
“As opposed to the generalization of ‘Well the prices are so high’,” said Abraham, “Let’s ask ourselves, ‘How high are they? And are there other places you could go as a consumer? “
This is part three in our series on hospital prices. Read part 1 and part 2.
Celia Llopis-Jepsen reports on consumer health for the Kansas News Service. You can follow her on Twitter @celia_LJ or email her at celia (at) kcur (dot) org.
The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW, and High Plains Public Radio focused on health, the social determinants of health and how they relate to public policy. Kansas News Service stories and photos may be republished by media at no cost with appropriate attribution and a link to ksnewsservice.org.