Local hospital price lists: Do they tell the whole story?
"DIFIB ICD SYS VR DF4" is listed at $15,762 for Aspirus Wausau Hospital.
That's the type of description you'll find when you hunt through price lists on websites for local hospitals, including Ascension, Aspirus, and Marshfield Clinic.
They now all report their gross prices for products and services directly on their websites. It's a new requirement from the Centers for Medicare and Medicaid Services (CMS) designed to promote transparency, but as it turns out, the information isn't all that usable.
It's provided using piece-by-piece components and codes only readable by the hospital, rather than as a complete procedure--for example, a knee replacement surgery. One would have to know each item, service, and prescription needed for the surgery before beginning to put together the gross cost.
Many items on price lists -- known as "Chargemaster" -- for all three area hospitals use similar descriptions to the one at the top of the article. Not being hospital accountants, we don't know what those descriptions stand for. And when we talked to officials at Aspirus and Marshfield Clinic, they didn't provide clear definitions.
The law leaves it up to hospitals to determine what constitutes a "standardized list". Locally, that means about 4,000 line items at Marshfield Medical Center, over 40,000 on Aspirus' website, and un-numbered lists on Ascension's.
The prices themselves, of course, can be pretty varied. For example, Marshfield Medical Center lists one option for a nursery room at $2,046, while Aspirus lists several "levels" of nursery rooms. The first one starts at $1,449, while level 2 immediately jumps to about $5,000.
Here's where area hospitals agree: almost nobody will ever pay these prices.
"It is going to be very confusing with the thousands of different entries on the Chargemaster for somebody to really know what pieces and components go into their care," noted the Vice President of Revenue Cycle for Aspirus, Lori Peck.
At Aspirus, even people without any health insurance won't pay the charges they see online.
"If you do not have insurance, we have an ability to discount those prices down to what you typically would receive, had you had insurance," Peck said.
During conversations with all three hospitals, they all pointed us to a different tool: Pricepoint. It's a standard they say Wisconsin already had before the new law, and that the regulations really just catch other states up to what Wisconsin has already been doing.
The tool isn't perfect, but it's format is more user-friendly, and it provides more information than Chargemaster. When you search for a knee replacement surgery as a patient with no insurance, you'll find estimates for the whole service. They'll compare prices for up to three hospitals: and locally, using the hospitals we've mentioned, that gross estimate for a knee replacement surgery ranges from about $27,000 to over $45,000.
Key differences between Pricepoint and Chargemaster is that you can easily compare prices, and you're shown the total estimates of procedures.
But Peck says Pricepoint faces many of the same challenges as Chargemaster in the long run. Namely, that the estimate will almost certainly never be the price you end up paying, once insurance and discount negotiations are factored in.
And whether you have insurance or not, finding the cost of your procedure is about as hard as ever--regardless of what online tool you're using.
"But it is an evolution, and it is something that patients can use as a first step in their process of understanding the cost of their care," Peck said.
It should also be noted that CMS doesn't actually have a plan in place to punish hospitals if they don't comply with the law. As they note on their website:
“Specific additional future enforcement or other actions that we may take with the guidelines will be addressed in future rulemaking.”
NewsChannel 7 spoke to all three hospitals to prepare this story, but Ascension and Marshfield Clinic declined to provide interviews. Instead, they provided written statements:
Ascension supports price transparency of our hospital services for the benefit of consumer choice and access to care for those we serve. In compliance with the CMS regulation, we have published a list of the amounts generally billed by the hospital based on the hospital’s chargemaster. Pricing does not reflect our financial assistance and charity care policy, and could vary by individual patient and by facility. We encourage those who are seeking or scheduling care to contact us for the pricing that is right for you.
As we discussed, this is just the base fee, and the overall price will look different for everyone due to differences in insurance coverage. If you have a procedure, other costs may be involved, such as anesthesiologists or other specialists you may see. The key is to check with your insurance provider on your coverage.