Polk hospitals among those lacking price transparency, nonprofit lists
LAKELAND — An advocacy group says Polk County hospitals aren’t providing all the pricing information patients need to seek out services and avoid receiving a surprisingly high medical bill.
A federal law stipulates that hospitals must display the prices of medical procedures. The goal is to help patients make more informed decisions, increase competition in the healthcare industry, and reduce the cost of healthcare.
While Polk hospitals have shown progress toward price transparency, their efforts have fallen short of legislated targets, according to a study released in February by the PatientRightsAdvocate.org.
Hospitals are required to post a ‘machine-readable file’ of charges online
The rule issued by the Centers for Medicare and Medicaid Services requires hospitals to post a “machine-readable file” of fees online for the services they provide.
Entries should also include the various rates it charges insurers and a user-friendly list of fees for the hospital’s 300 most “purchasable” services, which are considered pre-schedulable services.
Cynthia A. Fisher, who founded the advocacy organization, said that in Florida, negotiated rates – prices set between insurers and hospitals – are not fully disclosed or at all in order to be in compliance with the law, which was originally enacted in the Affordable Care Act and won bipartisan support.
The new hospital price transparency rule came into effect on January 1, 2021, requiring hospitals to publish all prices online, easily accessible without barriers such as submitting personal identifying information.
“It’s only in health care that patients have been blinded to not knowing prices before their care,” she said in a phone interview. “The same goes for purchasers of all health plans.”
About 175 million Americans are covered primarily by employer-sponsored health care plans, another 20 million on exchange and 10 million without insurance and the remainder have Medicaid or Medicare, Fisher said.
“If you think about it, we couldn’t see the insurance company prices or the hospitals and they made their deals in a back room behind closed doors and basically kept employers and patients in the dark. , allowing them to charge whatever they want,” Fisher said.
According to the advocacy group’s study, none of the Polk County hospitals they reviewed made their list to disclose to patients the true cost of care at their facilities, as required by law. Only 14% of hospitals in the country comply with the price transparency rule, according to the report.
While some progress toward full compliance has been made by Polk’s hospitals, the prices they list have still not eliminated all of the barriers the law seeks to remove for patients purchasing hospital services.
The advocacy group sends semi-annual reports, and its latest in February shows the following Polk County hospitals are noncompliant:
- Lakeland Regional Health Medical Center.
- Winter Haven Hospital – BayCare
- Advent Health Heart of Florida.
- Bartow Regional Medical Center – BayCare.
Lance Green, Executive Vice President and Chief Financial Officer of LRH, said in an email, “Lakeland Regional Health recently received correspondence from the Centers for Medicare and Medicaid Services stating that we are in compliance with all regulatory requirements for transparency of hospital prices.
“We are committed to providing price transparency for our patients and their families and to providing a price transparency page on our website where people can find more information,” he said.
A link he provided opens a price spreadsheet of more than 7,600 medical services and supplies for which a patient may be charged.
According to the patient advocacy group’s study, only 37.9% of hospitals nationwide posted a sufficient amount of negotiated rates, but more than half failed to meet other criteria, such as each insurer and named plans.
At LRH, many of the various columns of negotiated prices in its spreadsheet were broken down by health insurer, but due to the volume of data and industry jargon, it was difficult to immediately locate prices for each procedure for all the insurers listed on the spreadsheet. None of the hospitals contacted for this report provided a separate list of 300 purchasable services.
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The experience was similar on the AdventHealth and BayCare Health System websites, both of which host a price estimator, which asked for personal information such as health insurance information and email address of a patient in an online form.
“All BayCare-enabled locations are listed in the price estimator located on the BayCare website, and the services available for self-estimating include all 300 stores for each location,” said relationship manager Lisa Razler. public at BayCare.
“These estimates can be run as a self-pay estimate, or the estimate can be customized based on each person’s individual insurance information, if applicable,” she said.
“In addition, information continues to be updated regarding standard fees and negotiated rates for each hospital,” Razler said.
“This updated format and information has been released for Bartow Regional Medical, Winter Haven Hospital, South Florida Baptist and Morton Plant hospitals. As this is a very laborious process, BayCare continues to work on releasing additional data for the remaining facilities,” she said.
AdventHealth provided a similar statement via email.
“AdventHealth is committed to providing price transparency and providing consumers with information that will help them make informed decisions before receiving elective services,” said Amber Smith, spokesperson for AdventHealth Heartland Region.
“For Polk County AdventHealth Hospitals, we have posted a machine-readable file online of payor-negotiated rates for all payors and plans and provided a price estimator tool for consumers to calculate their out-of-pocket costs. for purchasable services, as required by the CMS price transparency rules,” she said.
Not all Florida hospitals were compliant in report
Not all Florida hospitals complied with PatientRightsAdvocate.org report, the following hospitals were in compliance with the rule in Florida based on the group’s report:
- Advent Health Tampa.
- Cleveland Clinic in Florida.
- Johns Hopkins All Children’s Hospital.
- Lakewood Ranch Medical Center.
- Mayo Clinic Hospital in Florida.
- North Okaloosa Medical Center.
- Sacred Heart Hospital on the Emerald Coast.
A Forbes magazine article said only 9% of American adults are aware of the rule and more than double, 22%, believe hospitals are not required to post prices for treatments and procedures, citing a Peterson Center report on Health Care and the Kaiser Family Foundation.
The advocacy group is not the only organization to criticize hospital pricing shortfalls. Research published in JAMA Internal Medicine in June 2021 found that among 100 randomly selected hospitals, 83% did not comply with at least one of the rule’s requirements, Forbes reported.
About half of hospitals provide the required user-friendly cost estimator; only 33% offer payer-specific negotiated rates.
A survey from CMS about Polk County hospitals’ compliance and any potential enforcement action was not immediately available.
An emailed statement from CMS said that as of early February 2022, CMS had issued approximately 342 warning notices to hospitals as well as 124 “corrective action plan requests” for hospitals that had been warned but did not had not corrected the problems.
“Details regarding hospital compliance and status are not publicly available,” CMS said. The agency said the rule states that once a hospital is hit with a monetary penalty, its name becomes public.
“Prematurely releasing this information could identify hospitals that have already taken corrective action and come into compliance after issuing a warning notice,” CMS said.
So far, he said, every hospital that has undergone a compliance review has either resolved its issues or is in the process of doing so. “Therefore, it was not necessary for CMS to issue sanctions.”
In a statement to the WREG television station in Memphis, the CMS acknowledged issues with hospital pricing website tools and said it was stepping up enforcement of the new policy by increasing fines to reach a potential $2 million a year for hospitals.
The agency’s ultimate penalty is to impose a fine of up to $300 a day, the station reported. When the rule was first proposed, many hospitals objected to disclosing their negotiated rates with different payers, saying the requirement would destroy their bargaining power.