New Law Requires Hospitals to Disclose All Pricing — Good Luck Finding the Data in RI
GoLocalProv News Team
New Law Requires Hospitals to Disclose All Pricing — Good Luck Finding the Data in RI
A new federal law, which took effect on January 1, 2019, requires each hospital in the country to disclose to the public the pricing for all medical procedures.
Good luck trying to find the disclosures and you will need more than a medical degree to understand the databases once you find them.
If you know what to look for, you can find out that a “condyle screw” used for orthopedic surgery at Newport Hospital costs $313.60 cents and the matching nut costs the same — an additional $313.60.
At Kent Hospital, the screw is only $299, but the pricing list does not include the nut. At Rhode Island Hospital, the pricing list includes more than 16,000 items, but the pricing for the screw is not listed under that name.
Price comparing that screw -- or trying to -- was relatively easy. For others, it was nearly impossible. At Rhode Island Hospital, the list shows that for “BUROSUMAB-TWZA 30 MG/ML SUBCUTANEOUS SOLUTION” the cost is $47,600.34.
According to Drugs.com, it is used as it “binds to and inhibits the activity of fibroblast growth factor 23 (FGF23), thereby restoring renal phosphate reabsorption and increasing the serum concentration of 1,25 dihydroxy vitamin D.”
Finding the Data on RI Hospital Websites
None of the information is easy to find on any of the hospital websites. Lifespan, CharterCare, and Care New England were responsive to media inquiries from GoLocal and provided the links to the pricing lists for each of their respective hospitals (see links at the bottom of the article).
South County Hospital did not respond to requests.
It is unclear if the hospital is complying with the new federal requirement.
The Value of the Data
The requirement was set forth by the Centers for Medicare & Medicaid Services to improve disclosure and transparency and the American Hospital Association and other healthcare industries have opposed the requirement.
The pricing list is called the “Chargemaster” in the hospital industry.
On the lists in Rhode Island, there are only two pieces of data listed in the massive spreadsheets. The name and the price. There are no codes for reimbursement or descriptions.
“The chargemaster is the equivalent of getting a full parts list for a car you purchased, down to every bolt, part and component — likely hundreds of items,” Bob Seeshausen, senior vice president of business development at Novant Health said in an interview with ABC News. “For instance, you will not find a knee replacement on most hospital standard charge lists. Instead, you will find all the resources required for the procedure, such as [operating room] time, anesthesia, recovery room, implants, drugs, physical therapy, etc.”
Each of the Rhode Island hospitals outlines the limitation of the data. On Miriam Hospital's website, it states:
The price of your care may vary from the listed charges due to a range of factors, such as the length of time in surgery, the equipment, supplies, or medications used, and the treatment plan your physician decides is best for you. In addition, insurers negotiate discounts with hospitals and other providers, while Medicare and Medicaid reimburse hospitals based on diagnostic related groups (DRGs), ambulatory payment classifications (APCs), or fee schedules. If you have health insurance, you should call your insurer to learn what your plan requires you to pay.
The lack of requirement by CMS to require the hospitals to make the data "patient-friendly" and the hospital's lack of desire has made the data difficult to compare or track.
