Hospitals Now Required to Disclose Prices

By Lura Jackson

In an effort to increase price transparency and provide better information to patients and consumers for medical care options, hospitals around the country are now required to publish their prices for the most common services performed there. While the new rule, implemented on January 1st, 2019, does enable consumers to have an idea of costs, it can also lead to more confusion.

The goal behind the rule, which was designed by Centers for Medicare & Medicaid Services (CMS), was to recreate the retail shopping experience for patients, enabling them to compare prices and make their decisions for care based on that. However, finding the operations in the data sheets of the hospitals is a task in itself, and the cost that is shown is rarely what patients themselves will need to pay – as insurance and other factors are generally always involved.

All hospitals are required by CMS to comply with the rule, with the potential for penalties involved if they do not. Calais Regional Hospital (CRH) is among the majority of hospitals in Maine that have already complied with the requirement.

Accessing pricing data for CRH is as simple as either going to their website at www.calaishospital.org and clicking on the “Patients and Visitors” drop-down menu and selecting “Hospital Bills and Insurance,” or by typing in the direct URL, www.calaishospital.org/crh.nsf/View/HospitalBillsandInsurance. Once on that page, scroll all the way to the bottom and click the link in the “Healthcare costs” section.

It isn’t simply a matter of accessing the file, however. The file itself is an Excel sheet listing close to ten thousand procedures and costs associated with a hospital stay, from particular kinds of medicines to screws. Finding the specific cost of an operation or item requires significant effort. CRH isn’t alone in how they have presented the data, with hospitals around the state utilizing similar methods to demonstrate their costs.

The new law requiring prices to be posted online does not immediately seem as if it will lead to greater patient awareness or choice. However, a law has been in place in Maine requiring hospitals to discuss pricing with prospective patients, and those who are concerned with cost should always speak with the hospitals they are considering in advance.

 

As an easy-to-use alternative option to find average costs, the State operates www.comparemaine.org, a website that compiles and maintains data from hospitals around the state. Using that website, costs for a selection of procedures – including blood tests, ultrasounds, and colonoscopies – can be found. Compared to the average for the state, CRH is routinely higher in costs, owing to its rural nature and critical care status. A colonoscopy with biopsy, for example, is listed as $3,121 at CRH, while the state average cost is $2,877.