AP NEWS

Lutheran, Parkview post prices

April 14, 2019

The two major local health care providers have posted procedure prices online, as required starting this year by the Centers for Medicare and Medicaid Services. The information, though, is sometimes incomprehensible and largely unusable.

Patients want to know how much they’ll pay out of pocket for, let’s say, having heart bypass surgery. But estimating costs before having such a procedure is basically impossible.

Geoff Thomas, Lutheran Health Network’s spokesman, explained in an email that “hospitals are paid different amounts by different insurers and ... hospitals can’t know in advance the exact cost of care : especially for complex cases.”

So, one patient might pay significantly more for a triple bypass operation than someone else who checks into the hospital for the same procedure, depending on insurance and how involved the procedure ends up being. Complications add to the total.

Consumers might try to approach the issue by compiling a list of several basic procedures and checking which local provider offers consistently lower prices. But even that doesn’t work.

At Parkview Regional Medical Center, vaginal childbirth without complications lists for 23,396, according to a listing that doesn’t spell out which complications the higher price would include. A hospital visit for “false labor” lists for $7,331.

Creating a comparable number for giving birth at Lutheran Hospital requires patience and a calculator. That’s because each item is listed separately, including 339 for newborn hearing screening and $526 for circumcision.

Lutheran lists “labor undelivered” for $1,699, but it’s unclear whether that’s the same as Parkview’s “false labor.” It’s also unclear from the listing whether Parkview’s price includes the cost of an epidural or circumcision : if either is desired, but spokeswoman Jessica Foor said it does.

The Centers for Medicare and Medicaid Services adopted the rule, which went into effect Jan. 1, to increase transparency in health care costs and empower patients, officials said.

User confusion

Edith Kenna, a local social worker, reviewed Parkview and Lutheran’s price lists at the request of The Journal Gazette. She didn’t find them helpful.

“The absolute comparing of prices is of very little value because we don’t know what all goes into procedures,” she said. “We’re not doctors.”

Kenna, who is also a member of Hoosiers for a Common Sense Health Plan, noted that car shoppers can choose to pay extra for attractive options on a new Jaguar, for example.

Healthcare consumers might spend as much : or more : on a knee replacement as on a luxury sports car, but they aren’t able to negotiate in the same way, deciding where to splurge and where to opt for the basic package, she said.

“When we have surgery, we don’t know the bells from the whistles,” she added.

Another factor that clouds consumers’ judgment is the fear they feel when they or a loved one has received a serious diagnosis, Kenna said. Often, they aren’t in any shape emotionally to make rational financial decisions.

“I think what’s wrong with our health care is its complexity. There are just so many variables,” Kenna said, citing insurance deductibles, negotiated discounts, and in-network vs. out-of-network.

“It’s like wrestling snakes in a barrel,” she added.

‘Informed choice’

The Centers for Medicare and Medicaid Services rule requires hospitals to publish standard prices online in a machine-readable format. But the rule doesn’t require disclosures be easy to use.

Lutheran’s disclosure comprises almost 9,000 separate listings, while Parkview’s disclosure comprises less than 700.

Some of Lutheran’s listings seem to be the same procedure at the same price but with different codes. For example, a pneumonia vaccine appears numerous times, always with the list price of $88. The same goes for a flu shot.

In January, Centers for Medicare and Medicaid Services Administrator Seema Verma told reporters during a conference call that requiring pricing information to be posted online is a first step toward health care cost transparency.

“From where we stand, this is about empowering patients, right? We want to make sure that the information is out there,” she said then. “The idea here is just to make the information available to individuals and let them make the decisions that work best for them.”

Foor, Parkview’s spokeswoman, said the health care system embraces transparency regarding pricing, quality and safety “so that patients can make an informed choice about their care.”

Parkview officials aren’t sold on the federal approach, however.

“While it may be well-intentioned, the new CMS requirement for hospitals to share their current standard charges, or chargemaster, may be confusing for patients because the charges listed represent the most basic level of hospital list price information available,” Foor said in an email. “The prices listed on the chargemaster are almost never the actual payments for which a patient would be responsible.”

“The best way for a patient to understand their out-of-pocket cost is to work directly with the hospital and their health insurance provider,” she added.

Getting care

Insurance companies negotiate discounts with providers in exchange for referring policyholders, giving those preferred providers higher patient volumes.

Although all policyholders with a particular insurance company might receive the same discounts, regardless of where they work, individual employers decide the terms and conditions of what procedures are covered for that group of workers.

The employer sponsoring the plan also decides how much it will contribute : a decision that determines how much of the cost is passed on to employees in the form of premiums, co-pays and deductibles.

Foor acknowledged that not everyone has coverage, however.

“Individuals without insurance may be eligible for financial assistance or hospital discounts : additional factors that are not included in the chargemaster,” she said.

Thomas, Lutheran’s spokesman, provided similar advice.

“Our goal is, and always has been, to help patients get the care they need, and we want them to understand their financial responsibility and the payment options,” he wrote in an email. “As each case is different, we have financial counselors available to work with patients : preferably well in advance of their treatment : to help them identify the best course for their particular situation.”

“For patients who have no insurance, we offer a variety of financial assistance programs, including charity care, prompt pay discounts and self-pay discounts for uninsured individuals,” Thomas said. “We also work with MDSave, a national web-based service offering patients significantly reduced prices for some services.”

Both health care systems encourage patients concerned about costs to reach out for assistance as soon as possible.

They also advise consulting human resources professionals at the patient’s work place, if applicable, and insurance providers about coverage.

sslater@jg.net