Before Kati Manley underwent a high-tech procedure to break up stones in her kidneys, she got a call from the hospital that shocked her. A financial counselor told Manley her share of the bill would be $4,000 and asked how she was planning to pay it.
No one told her what the total bill would be. And she didn’t know she could jump on the website of East Georgia Regional Medical Center—the hospital her doctor picked—to check prices, or that she could comparison shop at a different hospital and perhaps pay less.
“I wish I kind of knew that beforehand,’' said Manley, who works two jobs to make ends meet. “Because I’m willing to go to Augusta to get this done if I can get it done at a third of the cost.”
Most patients scheduling hospital procedures do so with little knowledge about prices, and hospitals for years have closely guarded price information. That is supposed to change under a new rule that took effect Jan. 1 requiring hospitals to prominently provide the information on their websites.
The challenge now is getting hospitals to comply. An Atlanta Journal-Constitution examination of 14 Georgia hospitals found that as of early July, only one made prices easy to find, and nearly half have skirted key requirements.
“The hospitals are finding different ways to ignore it or pretend that it’s not really there or they are doing a minimal compliance effort,” said Jeanne Pinder, founder and CEO at New York-based ClearHealthCosts, a journalism company, which found poor compliance in its independent analysis of U.S. hospitals.
There is widespread acknowledgment among hospital leadership that compliance has lagged, but the consensus has been to blame the pandemic for tying up hospital resources.
“It is important to understand that good-faith efforts to meet the new requirements can come at a cost,’' Molly Smith, vice president for public policy for the American Hospital Association, told the AJC in a prepared statement. “Pressures of fighting the virus did not go away because of the January 1 deadline.”
Every Georgia hospital in the analysis declined an interview to explain how they handled the new requirements. The AJC had to submit questions in writing.
In written responses, some of the hospitals acknowledged they did not provide all the required information.
Credit: Stephen B. Morton for The Atlanta Journal Constitution
Credit: Stephen B. Morton for The Atlanta Journal Constitution
“Hospitals are working as quickly as possible to remedy these concerns and reach full compliance,” wrote Anna Adams, spokeswoman with the Georgia Hospital Association.
One issue has been that hospitals want to be careful in the way they present prices, maintaining as much control as they can, said David Tyler, a partner in the health care advisory services practice at Grant Thornton, an accounting and advisory firm.
“I would say hospitals will do what it takes to be as compliant as they have to be,” said Tyler, who is based in Atlanta.
Meanwhile, more than four months after her procedure, Manley is still trying to pay off her medical debt. The 38-year-old eventually learned that the total price for her relatively quick outpatient treatment clocked in at $45,000, which is partly why her share was so high. The Statesboro woman, who works as a schoolroom assistant and as a cashier and deli assistant at a local grocery store, says she is devoting all her extra money for the year to pay the bills.
“Doctors, health care providers, they should make this stuff easy to understand,” Manley said. “Make it easy to find. ... Not everybody is going to be savvy enough to research and find this kind of information.”
‘Consumer friendly’ requirements
In trying to improve price transparency, the U.S. Centers for Medicare and Medicaid Services requires two separate online tools.
Each hospital must list standard charges for all of its items and services in a machine-readable file. That file must include gross charges, discounted cash prices, and minimum and maximum charges for services that hospitals negotiate with insurers.
Transparency advocates say the machine-readable file is directed at sophisticated users of the information, including healthcare consultants, online tool and software developers, healthcare providers and employers.
The second tool is aimed at encouraging consumers to price shop.
Hospitals must prominently post a “consumer-friendly” shoppable services list, so that patients can estimate total costs and their share. Shoppable services include those items that patients can schedule, such as MRIs, colonoscopies and cataract removal. The list has to include a “plain-language” description and any primary code used by the hospital for billing. And hospitals can’t require consumers to register or provide personally identifiable information to see prices.
Some Georgia hospitals barely met standards set by the rule, the AJC analysis showed.
Northside Hospital Atlanta received the lowest compliance rating in the AJC analysis. It stood out as the single hospital in the pack of 14 that did not provide a machine-readable file listing all charges for items and services.
“Unfortunately, machine readability of pricing data provides no context — such as the impact of insurance payments, which generally is significant and favors most patients,” Northside’s senior vice president for communications Lee Echols told the AJC.
Northside also failed to have a way for consumers to look up prices for shoppable services. The hospital set up a page where consumers supposedly can search for them. But the search doesn’t work.
A disclaimer on the website says: “Please check back. We are working to get this site up as soon as possible.”
Several hospitals had multiple data fields missing. Piedmont Atlanta’s machine-readable file, for example, includes only gross charges, not prices negotiated with insurers or discounts offered to those who pay cash. A Piedmont spokesman told the AJC the hospital had used a popular software program to meet the requirement but gave no other specifics.
Only Memorial Health in Savannah followed a basic directive that hospitals display the price transparency data in a prominent location. The top half of the hospital’s home page highlights a link to the pricing tool. “We are committed to supporting efforts to provide relevant information to help patients understand what their out-of-pocket costs may be for hospital care so they can make informed decisions,’' a spokeswoman told the AJC.
At most hospitals, though, it is like a game of Where’s Waldo to find any information on pricing. Many require patients to scroll and search through various drop-down menus to reach the pricing tools.
Tapping a loophole
When it comes to providing a consumer-friendly, shoppable list of services that patients can use to compare prices, most hospitals ducked disclosures of specific prices.
Only Wellstar provided a list on its website of prices for 300 standard medical procedures.
CMS allows hospitals to skip the requirement by providing an alternative patient payment estimator tool, to calculate an individual patient’s estimated cost for a selected procedure. Numerous hospitals touted the estimator as an ideal solution for patients who need pricing but who don’t want to register online or phone to discuss charges.
“We know navigating healthcare costs can be complex, which is why our goal continues to be to provide a hassle-free experience to consumers,” Piedmont officials told the AJC, referring to its patient payment estimator.
One benefit of such a tool is that it can incorporate costs that may not be visible to patients when they look at a list of individual shoppable services, said Tyler, the Atlanta-based healthcare industry consultant.
Patients “get what is expected to be an entirety of services,’' he said. “That includes labs, X-rays, additional supplies you may need while you are at the facility.”
But critics say the estimator is another device to keep patients in the dark about costs. By providing an estimator, hospitals can skirt many of the disclosure rules, including key data requirements, making the tool not much different from the phone hotlines that hospitals have provided for years that are rife with inaccuracies.
Phoebe Putney failed to provide prices for a minimum of 300 services on its price estimator. Officials said the hospital had spent months trying to comply with the rule and paid a vendor to create its web pages, but the vendor’s software actually deleted many of the prices. Phoebe fixed it after being contacted by the AJC.
That price estimator was also difficult to find. Phoebe Putney’s main “Price Estimates” page indicated that customers must call during working hours to get an estimate, without mentioning that an online price estimator was available but hidden away on a different page.
“We believe we have been an industry leader in adhering to (state hospital transparency laws) and CMS Price Transparency Rules by ensuring that information is as easy to access and understand as possible,” Phoebe told the AJC.
Some other hospitals said they could not provide all the information because of the complexity of health care pricing. For example, it is impossible to ascertain an estimate for services that are bundled into other procedures, said Elizabeth Nikels, spokeswoman for Southern Regional Medical Center in Riverdale.
“These services will not have any payer specific negotiated rates or the minimum and maximum,” Nikels said. But “whenever possible, we have provided the minimum and maximum rates for all services within the standard charges file.”
St. Joseph’s Hospital in Savannah and Emory Hospital Midtown received the highest scores from the AJC’s review. St. Joseph’s officials told the AJC the hospital had “engaged multiple external experts to guide us through the new rules and assist with ensuring full compliance with the law.”
Emory said it enlisted a cross-section of departments in development of its website. “Our goal was, and is, to have a website that is both compliant and useful to patients and industry stakeholders in a manner that is consistent with the intent and purpose of CMS’ Hospital Price Transparency Rule,” the hospital said in a written statement.
