SHERIDAN — A new regulation that requires hospitals to list their baseline charges for procedures has local hospital officials concerned that the practice will give patients an inaccurate perception of what their treatments could cost.
Hospitals nationwide began listing prices on Jan. 1 in response to a new federal regulation from the Centers for Medicare and Medicaid Services. Previously, hospitals had to make a list of its charges available upon request, but the new regulation requires hospitals that receive CMS reimbursements to publish its standard list of charges in a “machine-readable” form online.
The prices listed are based on each hospital’s “chargemaster,” the baseline price list hospitals use to negotiate with insurance companies. That means virtually no patient will pay the listed prices, because insurance or patient assistance programs will alter the fees.
Sheridan Memorial Hospital Chief Financial Officer Nathan Stutte said SMH hopes its patients will make the effort to understand the prices listed online in context.
“We encourage the continued push for price transparency for patients,” Stutte said. “Our only concern organizationally, and what I’ve heard from some of my peers, is if patients want to go out there, that (chargemaster) file doesn’t do much for a patient.”
The chargemaster prices are listed as components that will most likely need to be combined to constitute a comprehensive treatment. For instance, Stutte noted that the chargemaster list displays the price for an individual heart stent. In many cases, patients will need multiple stents installed during surgery and the number used will be determined by a doctor based on the severity of the patient’s heart ailment. The patient’s stay in the hospital might also require tests and related procedures which, again, need to be ordered by doctors. In other words, a patient may not have an accurate inventory of the charges they are incurring until they have begun treatment.
Wyoming Hospital Association President Eric Boley said hospitals around the state are making efforts to help patients account for the discrepancy between listed prices and what they actually pay.
“Wyoming hospitals stand ready to assist patients in understanding what is being billed and their total out-of-pocket costs,” Boley said.
Locally, Stutte said SMH has financial advocates available to help patients understand the financial resources available to them and how those resources will likely impact the cost of their treatments.
“The best avenue to get an idea of what a procedure will actually cost is our financial advocates through our billing office,” Stutte said. “They can go into great detail with (patients) about what they can expect a procedure to cost.”
Financial advocates can also help uninsured patients find assistance in paying for medical costs, Stutte said. SMH lists the contact information for its financial advocates, and its chargemaster list, on the billing and insurance section of its website.
The new regulation adds to the already overwhelming flood of information available to prospective patients, but officials say the best research available to patients remains working with their local health care professionals.