Richard Davis: Hospitals provide disclosure without transparency
As of January 1, the Centers for Medicare and Medicaid Services (CMS) requires hospitals to put their charges on their website and update that information on a yearly basis. The spirit of that mandate was to create more transparency in health care costs, but instead hospitals have provided disclosure without transparency.
Hospitals use a list of prices called a chargemaster. It is a convoluted list of every item a hospital has set charges for. When the disclosure mandate was handed down hospitals knew they had an easy way out by simply putting a link on their website to a chargemaster Excel spreadsheet. Once you look at one of these lists of about 20,000 items, as is the case for Brattleboro Memorial Hospital, it is clear that even an actuary would have trouble deciphering any significant meaning from this list.
A recent Kaiser News story summed up the situation pretty clearly stating, "As of Jan. 1, in the name of transparency, the Trump administration required that all hospitals post their list prices online. But what is popping up on medical center websites is a dog's breakfast of medical codes, abbreviations and dollar signs — in little discernible order — that may initially serve to confuse more than illuminate."
They go on to note that, " chargemasters, are massive compendiums of the prices set by each hospital for every service or drug a patient might encounter. To figure out what, for example, a trip to the emergency room might cost, a patient would have to locate and piece together the price for each component of their visit — the particular blood tests, the particular medicines dispensed, the facility fee and the physician's charge, and more. "I don't think it's very helpful," said Gerard Anderson, director of the Johns Hopkins Center for Hospital Finance and Management. "There are about 30,000 different items on a chargemaster file. As a patient, you don't know which ones you will use."
I did some exploring of Vermont hospital websites and verified what Kaiser News has reported. Brattleboro Memorial Hospital has followed the national trend and buried the price list deep within its website. First you have to go to the Patient Information page and then go to Patient Financial Services. Near the bottom of that page is a sentence that states, "For information about Brattleboro Memorial Pricing click here (a hyperlink) or call 802-251-8492.
When you click the link you come to the chargemaster Excel spreadsheet. I looked at one specific charge under ED Pro Fees. The next column titled Long Description contained "13120 REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM ProFee". A few columns over the Short Description column said "13120 REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM ProFee".
There are three columns for charges: Hospital Technical Fees, Hospital Professional Fees and Clinic Global Fees. In this case only the Hospital Professional Fees had a number, which was $688.
My best guess is that this entry means the hospital charges $688 for someone to sew a complex laceration of your scalp, arm or leg. If you want to find out all of the other charges associated with such an ER visit you have to know what they are and then look up each one individually.
To its credit, our local hospital does provide a number to call to hopefully clarify the complexity of the world of the chargemaster. But sadly, it is clear that most American hospitals are satisfied to hide behind the complexity of their chargemaster rather than do the work that would be required to provide a list of common average charges for common procedures and hospitalizations.
So much for the hope of having the public provided with even a small degree of transparency in hospital pricing.
Richard Davis is a registered nurse. He writes from Guilford and welcomes comments at firstname.lastname@example.org. The opinions expressed by columnists do not necessarily reflect the views of the Brattleboro Reformer.
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