More than four years after she voiced concerns about the difficulty of finding clear pricing information for hospital services, governor-elect Maura Healey said the calculation of these costs remains complex. We would not expect to be overly satisfied with recent research showing that it is a complex process.
Finding information about medical procedures on Massachusetts hospital websites can be “a roundabout or frustrating process,” according to a Pioneer Institute report.
A conservative financial watchdog surveyed a sample of 19 Massachusetts hospitals for compliance with the Public Health Services Act, which took effect January 2021 after adoption of the regulation by the federal Centers for Medicare and Medicaid Services. was evaluated. The hospitals studied were “hospitals of all sizes in urban, suburban and rural areas across the state,” the researchers said.
In addition to finding “large variability in prices for some common procedures,” the researchers found that 37% of the hospitals surveyed offered discounted cash price information (hospitals pay cash). rate charged to individuals) is not available.
According to the Pioneer Health Report, “Even among hospitals that post discounted cash prices, adherence to posting prices for all procedures for which it is mandated varies”. Rates ranged from as low as 60% to as high as 97%.”
Researchers found a price variation of nearly 100% for abdominal ultrasounds to over 300% for MRIs of the leg joints. Other variations cited in the report include prices for a bilateral mammogram, ranging from as low as $962 at Lahey Hospital and Medical Center in Burlington to as low as $392 at South Shore Hospital in Weymouth. was in the range of
“These disparities indicate that the market is dominated by a particular system that allows prices to remain above the competition standard,” the report said. “This is why provider price transparency is important information that consumers, employers, benefits managers and insurers have immediate access to.”
This is due to the small, unaffiliated suburban and rural hospitals that have historically received lower reimbursement from insurance companies for the same procedures with similar outcomes than larger Boston-based hospitals. It was a longstanding complaint of the hospital.
The report, released Nov. 17, includes recommendations to appoint one administrator for price transparency at each hospital, strengthen federal price disclosure rules, and make pricing websites more consumer-friendly. It includes several recommendations, including federal guidance on – friendly.
At the state level, the report suggests creating incentives to improve hospital compliance rates.
“Some consumers believe that price doesn’t matter because they have good health insurance, so the lack of information about health care prices may not be a problem,” the report said. the book says.
“But this is wrong, because we are all paying for increasing health care costs, directly or indirectly, through premium increases. Lack of price transparency is causing problems, either because it is expensive or because consumers are underinsured.”
That final statement should resonate with outgoing Attorney General and soon-to-be governor Healy.
As the state’s chief law enforcement officer in October 2018, she told the Health Policy Board that it is “often nearly impossible” for patients to obtain pricing information before they receive services. Told.
This is of particular concern as people are increasingly subscribing to insurance plans with high deductibles.
Similar to the Pioneer Institute report, Healy cited studies at the time showing that the same service could cost $1,000 in one hospital and $300 in another, showing wildly different prices.
The complexity of the system is highlighted by another study that found seven employees involved in billing operations for every 10 doctors, she said.
Healy told HPC to reduce the financial and administrative complexity of healthcare as a goal of its continued efforts to address moderately rising costs, which are consistently of great concern to individuals, families, businesses and governments. , advised that the goal should be to increase price transparency.
It’s not clear where the cost of the hospital services at issue ranks on Healey’s priority list when he takes office in January.
Due to the often confusing nature of our state and national health care systems, finding viable solutions to competing cost factors requires more perseverance and perseverance than has ever been expended. It is clear that it is necessary.
But health care accounts for about 40% of the state’s annual budget, so it’s an issue that Healy cannot ignore.
