Texas hospitals react to new mandate to post health care prices

State & Regional

AUSTIN (Nexstar) — Hospitals across the U.S. will have to post prices of standard services online in a machine-readable format starting Jan. 1, 2019. 

The policy changes were first proposed in April of this year. HHS’s Centers for Medicare and Medicaid Services (CMS) said this change, along with others, would advance Secretary Alex Azar’s agenda “for moving to a healthcare system that pays for value, as well as a request for information regarding future value-based reforms.” 

The reporting must list every item and service by the hospital, as well as any charges related for them as it is represented in the hospital’s list of official rates. 

According to the Texas Hospital Association, hospitals throughout the state currently use Texas PricePoint, which is an online portal that is designed to provide information on prices for the most common inpatient services and quality data. The portal also includes contact information for Texas hospitals. 

Seema Verma, administrator of CMS, said in a November blog post that price transparency is a priority for the Trump Administration. Verma also announced a new consumer resource, called Procedure Price Lookup. It is a Medicare.gov tool that allows patients to compare Medicare payments and co-payments for certain procedures that are both performed in hospital outpatient departments and ambulatory surgical centers. 

“Giving patients access to data is just the first step – we also need to drive towards consumer-friend tools presenting information that is both personal and actionable at the time people seek care,” Verma wrote. “We need to meet patients where they are and integrate cost information into their health care decision making, making it easy for patients to analyze cost differences across all care options.  The case for price transparency throughout the health care system is clear, and the need to shop is growing ever more compelling as high deductible plans become the norm. 

But, Lunsford said the number on the price list posted by each hospital will likely not match what’s on a patient’s final bill. 

“The most feasible and most accurate tool in a lot of these situations is going to be something you get through your health insurance plan,” Lunsford said. “For example, your Blue Cross Blue Shield app if you have Blue Cross Blue Shield or if you have Aetna. There are generally apps available that are provided by the network company. You’ll be able to see the in-network providers and you’ll get much more of a sense of what you’ll be out of pocket from those kinds of resources.” 

Negotiated rates are often determined by the number of people in the health plan and by the number of people who are in the group. Bills patients may receive outside of the negotiated rates between the insurance plan and provider could be from the providers that are not in-network, Lunsford added. 

He urges consumers to consult their health plans when they decide on a service. 

The Texas Association of Health Plans praised the new mandate. 

“All parties involved in the health care system, including health plans, doctors and hospitals, have an obligation to help the consumer find the right care at the right time for an affordable price,” said TAHP CEO Jamie Dudensing. 

Abilene Regional Medical Center issued a statement saying its goal has always been to get patients the care they need and for people to understand their financial responsibility.

“We accept most insurance available in the community, which will generally determine a patient’s out-of-pocket payment that is far less than standard charges,” the emailed statement from Director of Marketing Delores Cox said. “For patients who have no insurance, carry out-of-network insurance, or who receive services their insurance does not cover, we offer a variety of financial assistance programs, including charity care, prompt pay discounts, and generous self-pay discounts for uninsured individuals.”

Ascension, which operates Providence Healthcare Network and Seton Healthcare Family and Dell Seton Medical Center at The University of Texas, also said it supports price transparency, but the list doesn’t tell the whole story.

“Pricing does not reflect our financial assistance and charity care policy, and could vary by individual patient and by facility,” a spokesperson issued in a statement. “We encourage those who are seeking or scheduling care to contact us for the pricing that is right for you.”

Copyright 2019 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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