Hospitals in Idaho and across the U.S. must publish their prices. But the “prices” can be misleading and hard to interpret, because they do not predict what a patient will actually end up paying. Instead, they provide others in the health care industry with a look at what their competitors are charging and getting paid by insurers. (Illustration from public spreadsheets by Audrey Dutton/Idaho Capital Sun)
How much does it cost to fix a split lip at your local hospital? Based on data hospitals are now required to share, it could be $208 or $49 or $570 — but it’s probably none of those.
Hospitals across Idaho and the U.S. are required to publish what they charge for individual health care services, along with their cash discount price and the special rates they’ve negotiated with health insurance companies.
The federal regulations that forced these acts of transparency also require hospitals to publish the prices of some non-emergency services, so patients can “shop around” to find the best deal. These disclosures are posted on each hospital’s website in spreadsheets, often labeled “shoppable services” and “standard charges.”
But a review of price transparency files for hospitals across Idaho shows that “standard charges” are anything but standard.
Health care transparency or a data dump?
Federal health officials and interest groups have pushed, for more than a decade, to make health care prices more visible to the general public. Slowly, federal rules have kicked in that require hospitals to publish their “chargemaster” rates — the sticker price for every conceivable line-item charge on a medical bill — and more information meant to empower consumers.
The rules recently rolled out to insurance companies, requiring them to make it possible for people with insurance to get an online cost estimate.
The Idaho Capital Sun reviewed price transparency files for about a dozen hospitals — from Idaho’s largest health systems to one of the smallest standalone hospitals, Lost Rivers Medical Center in Arco.
Some price transparency files show what a patient would be charged for stitching up a split lip, for example — but also show the charges for other things that usually accompany those services, such as a fee for visiting the emergency room and a fee for the medical supplies. But other files are put together in a way that leaves it up to the patient to figure out those extra fees.
All of the files use medical billing terminology and billing codes — which makes them readable to competitors in the health care industry, but likely to confuse a person who just wants to know which hospital has the cheapest knee replacement surgery.
Let’s say you have a kidney infection …
The sticker-price charge for an otherwise healthy patient to be hospitalized with a kidney infection is $11,977 at Gritman Medical Center in Moscow, and $18,954 at Kootenai Health in Coeur d’Alene.
But nobody actually pays that. The hospitals offer 15% to 25% off the bill for patients who pay in cash. And health insurance companies have agreed to pay the hospitals anywhere from $6,014 to $75,333 for the same group of services.
The files show such wide variations without an explanation for them. The files also do not account for one big reality: health insurance isn’t all the same. A person’s health plan might cover 100% of their costs — paying their whole bill — or it might cover 90% of their costs after they’ve already spent $5,000, or it might cover none of the bill.
That’s partly why health systems and hospitals urge patients to call ahead if they would like a price estimate based on their insurance benefits and the health care service they need.
St. Luke’s Health System is one of several Idaho hospitals that don’t publish the rates they’ve negotiated with individual health insurance companies. Instead, they provide average negotiated prices.
“Our goal is to provide patients with a meaningful and accurate picture of cost so they can make informed decisions about their care,” St. Luke’s said in an emailed statement. “Our focus on estimates over (publishing detailed spreadsheets) allows us to provide patients with a much more accurate financial picture of their service than a spreadsheet would be able to.”
Medicaid pays the least for medical care
Medicaid covers about 1 in 5 Idahoans, according to the Kaiser Family Foundation. Since it commands such a huge share of the market across the state, major hospitals have little choice but to accept Medicaid insurance — and whatever pay rate it offers.
Idaho, like other states, keeps a tight grip on its Medicaid purse. The price transparency files show that, in almost every situation, the insurance that pays the least for health care services is Medicaid.
Hospitals and clinics lose money when they care for Medicaid patients. To make up for those losses, they negotiate higher prices with private health insurance plans.
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