Health-care experts: Transparency mandates won't be useful to patients

Local hospital officials said this week implementing federal mandates to publish prices publicly will, in reality, be of little value to patients.

In 2018, the Center for Medicare and Medicaid Services, or CMS, finalized a rule requiring hospitals to establish and make public a list of their standard charges, in an attempt to increase price transparency for patients, according to www.cms.gov, and prices were required to be online by Jan. 1.

Steve Haas, SoutheastHEALTH CFO

Two major factors contribute to this move being of little help to patients, said Steve Haas, CFO of SoutheastHEALTH in Cape Girardeau: The prices are list price and often have little bearing on a patient’s actual cost, just like buying a car; and outcomes are difficult to predict ahead of time as each patient is different.

David Prather, CFO of Saint Francis Healthcare System, agreed. He noted the hospital charges a contracted amount, depending on whether the patient is insured, uninsured or has Medicare or Medicaid.

David Prather, Saint Francis Healthcare System CFO

It’s more useful to create what Prather referred to as an out-of-pocket estimate, which would more accurately reflect a patient’s anticipated cost for a given procedure or hospital stay, factoring in an insurance carrier’s coverage, for example.

But, Haas said, insurance carriers offer different plans, and if a patient isn’t familiar with his or her insurance coverage, knowing list prices isn’t going to help much.

Shauna Hoffman, vice president of marketing and development at SoutheastHEALTH, said coverage was more straightforward several years ago, but over time, the burden of cost control has shifted to patients — who have more of an incentive to watch costs, as it directly affects them.

Haas said he sees the takeaway as this: “Collaborate with your care team. Ask questions, and be sure you’re asking the right questions.”

Haas said patients need to ask about every test, every procedure before it’s performed, to understand the cost and understand whether it’s covered under the patient’s particular insurance plan.

Additionally, depending on whether a physician is in or out of network, that particular work performed may not be covered at all, Haas said.

If a specialist is operating within a hospital, for example, and the hospital is in network, but the specialist isn’t, that specialist’s services might be covered only partially.

Patient advocates at SoutheastHEALTH are there to help people navigate this process, Haas added.

“The patient really has to ask a lot of questions,” Haas said.

Both major hospitals in Cape Girardeau have more than 20,000 line items listed, including procedures, supplies, services, and more.

SoutheastHEALTH has more than 21,000 line items listed, and SFMC has nearly 23,000 line items in the downloadable spreadsheet available online, as of Friday afternoon.

Prather said SFMC’s software system, implemented in 2016, was a major investment, and while the listing process did take some time, because of the software, complying with the new requirement was a more streamlined process.

Similarly, Haas said at SoutheastHEALTH, the information was always there, but it’s now formatted and publicly available.

But the information being publicly available hasn’t made for a large reaction, both officials said.

“Prior to Jan. 1, we had maybe two calls a day. We probably have the same average now,” Haas said, and Hoffman agreed, saying “It’s business as usual.”

Prather said existing customer service staff members are fielding calls.

Haas said he hopes, ultimately, more patients become more engaged in the whole process of their care, whether as a result of the prices being publicly available or not.

“That will provide a better patient experience, before and after,” Haas said.

mniederkorn@semissourian.com

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