Anyone looking for dinner in Keene can easily go online and, in a few clicks, find menus with prices for dozens of local eateries. They can compare the prices for similar dishes at pizza places, Chinese restaurants, sub shops and more.
Need to insure a vehicle? Nearly every company has a calculator through which you can get a quote, which includes being able to choose coverages and options.
But if you need an EKG and stress test for your heart, a hip replacement, or are expecting a child, good luck finding out what it will cost. If you have insurance, you can perhaps rely on your coverage page and figure it out based on whether it’s a covered procedure, how much is left on your deductible and whether a co-pay or coinsurance applies — and even then, the price could vary wildly depending on where you have it done.
It shouldn’t be hard to find out what medical care will cost, but it is. And that’s one of the biggest problems in obtaining care.
A law passed in 2019 through the Affordable Care Act aimed to fix that, requiring hospitals to make their prices clear. So far, not so good. Hospitals were supposed to provide — in an online, searchable way — their rates for 300 common services, like X-rays and lab tests, as well as the amount hospitals are willing to accept in cash and their negotiated rates with insurers.
A report issued last week from PatientRightsAdvocate.org found that seven months after the law took effect in January, a whopping 5.6 percent of hospitals nationwide had complied. None of the hospitals in this region — Cheshire Medical Center in Keene, Brattleboro Memorial Hospital and Monadnock Community Hospital in Peterborough — were found to be compliant. Each had some information, but not all that’s required, according to Patient Rights Advocate.
None had the required “shoppable” list of rates for 300 common services, nor information on negotiated rates with each insurer. Officials at Cheshire and Brattleboro Memorial said they thought they were in compliance with the information they do provide. None of the hospitals has yet been flagged by the Centers for Medicare and Medicaid Services for any violations.
One of the biggest issues with medical costs — aside from hidden charges that providers simply never reveal in advance; so-called “surprise billing” that’s the subject of other legislation — is that they vary greatly from provider to provider, with little accountability. The price transparency requirements were put in place to make clear to patients exactly what the costs would be. Part of that is knowing what they’re paying compared to the deals insurers can obtain, for better or worse.
Cheshire’s CFO Dan Gross wondered whether the hospital can legally release its negotiated rates, to which we’d say it probably wouldn’t be in the law if they couldn’t. He further equivocated by saying even if a patient knows the basic rates, their individual condition and possible complications could change the cost dramatically. That’s certainly true, but we’d also note that in such a case, a provider whose rates were transparently lower would also be likely to cost less under those circumstances.
Monadnock Region hospitals didn’t fare poorly in the report; all had made efforts to make prices available. They just haven’t yet met the full requirements.
Health care is among the largest expenses Americans face, whether they have insurance or not. For far too long patients have had little leverage in determining just how expensive it is. Particularly in more rural areas, where providers are fewer, the default has simply been to go to the nearest facility that could treat your condition. Comparison shopping was rare and only for those willing to spend many hours on the phone.
Not only has the Internet provided easy access to such comparisons, Americans have, since the passage of the Affordable Care Act, become more aggressive in seeking to lower their costs in the face of rising insurance premiums, drug costs and other health care expenses.
When the transparency law was passed, hospital associations actually sued to keep their prices secret, but were unsuccessful. Ask yourself why they might do that. The answer will be evident, and argues for greater transparency.