If you're looking to schedule certain medical procedures, you can now shop around to compare prices.
A federal law took effect Jan. 1 that requires hospitals to post price lists online for colonoscopies, mammograms and vasectomies in a form that can be downloaded. They must be updated annually. Both Genesis Health System and UnityPoint Health have complied with the law, which may allow patients more predictability in their hospital stays.
“We used to submit them and then a patient could see them if they went to the State Hospital Association website,” said Henry Marquard, Genesis Health System government and community relations officer. “What’s different now is that all hospitals are posting them directly themselves, and have greatly expanded the number of services that we’re including.”
Genesis focused on more common procedures before, Marquard said. Now they are striving to include all procedures.
Prices vary between companies. A colonoscopy with a biopsy is estimated to cost $4,100 at Genesis Health System, while a Level Four colonoscopy costs $3,061 at UnityPoint Health.
The new system is not perfect, Marquard said, cautioning there can be a variance between posted and actual prices.
“It’s a good idea, the idea that CMS (the federal agency Centers for Medicare and Medicaid Services) is working on which is to reduce surprise bills and help patients plan for expenses and whatnot,” he said. “Ultimately, we don’t think that it’s actually all that helpful in accomplishing that goal.”
The biggest problem, Marquard says, is the average cost of the procedure is not what patients will pay, because that varies based on what a patient's health insurance covers. “What you’re going to actually pay is going to based almost solely on whatever your insurance is unless you’re talking about out-of-network.”
There are many variables to hospital billing prices, Jacquard added. An average procedure may require a one-night hospital stay, but a patient may need to stay two nights, which would increase prices.
Bringing insurance into the mix improves the accuracy of average pricing, Marquard says. “Until we’ve got something that’s able to factor in what their insurance carrier, what the specific plan entails, it’s never going to be accomplishing what it set out to.”
Heather Nahas, UnityPoint Health director of marking and communications, said the health care system is looking for ways to simplify the information and make it easier for patients to understand. Nahas says UnityPoint Health's charges are the same at Quad-Cities area facilities but may vary across different organizations or geographic locations. Variables include the size of a facility, complexity of services offered and insurance providers.
“However, if a patient is looking for cost information specific to their care, we encourage them to call us for an estimate at 1-833-23-PRICE,” Nahas said. “UnityPoint Health works one-to-one with patients to provide individualized cost estimates based on the type of care they may receive and their insurance plan.”
On a conference call Thursday, Seema Verma, CMS administrator, said the status quo was unacceptable.
“Doing more of the same will not fix this problem, so we must move the health care system on a different trajectory, one that points it toward what has always been its primary mission: serving the interests of patients," Verma said.
The lack of price transparency is a significant barrier to value and “unlocking’ cost information is critical to enable patients to become active consumers, she said.
CMS has asked for feedback from stakeholders before the process moves ahead, Verma said.
“We know this issue is complex, which is why we’ve asked for input from our stakeholders on key issues, like how to identify standard charges, what types of information would be beneficial to patients and what enforcement mechanisms will be most effective," she said.
Verma said the goal is to ensure patients have the right information at the right time to make a decision.