DENVER (KDVR) — The true cost of an upcoming medical procedure may be difficult to obtain, according to a new report conducted by the Patient Rights Advocate.
The consumer group released a new report showing that nearly 20 months after a law requiring hospitals to post their real prices online went into effect, a large majority of hospitals continue to hide the cost of care from consumers, including several from Colorado.
“The hospitals have put the brakes on complying with this law and every day that a hospital doesn’t show its actual prices in advance of care, it harms patients because 64% of patients delay care for fear of financial ruin,” Cynthia Fisher, founder and chairwoman of PRA, said.
Fisher said most hospitals are posting prices but in a format that’s often fuzzy and misleading about a procedure’s true cost, making the information useless for consumers.
“By keeping patients in the dark, hospitals continue to charge whatever they want,” Fisher said. “Why wouldn’t any American choose to shop and get a $300 MRI versus paying $3,000?”
Nationally, PRA found only 16% of the hospitals it surveyed were complying with the rule.
Yet, the Centers for Medicare and Medicaid Services have only fined two hospitals in Georgia for noncompliance. PRA said both hospitals became compliant within a month after each was fined nearly $1 million.
“Without enforcement, it will be decades before we get these prices revealed,” Fisher complained.
The PRA survey looked at 32 hospitals in Colorado and determined only one is in compliance, Middle Park Health Kremmling.
The hospitals in Colorado that are not complying according to PRA are:
- Arkansas Valley Regional Medical Center
- Avista Adventist Hospital
- Castle Rock Adventist Hospital
- Centennial Hospital
- Children’s Hospital Colorado
- Children’s Hospital Colorado – Colorado Springs
- Good Samaritan Medical Center
- Haxtun Hospital
- Heart of the Rockies Regional Medical Center
- Kiowa County Hospital District
- Kit Carson County Memorial Hospital
- Littleton Adventist Hospital
- McKee Medical Center
- North Suburban Medical Center
- Parker Adventist Hospital
- Platte Valley Medical Center
- Porter Adventist Hospital
- Presbyterian/St. Luke’s Medical Center
- Rangely District Hospital
- Rose Medical Center
- SCL Health St. Joseph Hospital
- Sedgwick County Health Center
- Sky Ridge Medical Center
- Spalding Rehabilitation Hospital
- St. Francis Medical Center
- Swedish Medical Center
- Swedish Southwest ER
- The Medical Center of Aurora
- UCHealth Highlands Ranch Hospital
- University of Colorado Hospital
- Vibra Hospital of Denver
The Colorado Hospital Association told the Problem Solvers it has “significant concerns” about the PRA report and released the following statement to FOX31:
CHA and its member hospitals have a long-standing history of supporting price transparency. We strongly believe that patients should understand their insurance benefits and have access to price information in order to make informed decisions about their health care.
Colorado hospitals and health systems are committed to complying with the federal hospital price transparency rule and have invested significant time, money, and resources to do so. In a survey CHA conducted earlier this year, 90 percent of hospitals surveyed indicated they are fully compliant with the federal rule. Those that weren’t at the time of the survey had a plan in place to come into compliance.
The Centers for Medicare and Medicaid Services (CMS) monitors compliance with this rule and has the ability to impose significant monetary penalties on hospitals for noncompliance. To date, no Colorado hospitals have been assessed a financial penalty. In addition, the Colorado General Assembly passed legislation this year to prohibit hospitals from certain debt collection practices if they are found to be noncompliant.
Colorado Hospital Association
The legislation referred to by the CHA is HB22-1285 which goes into effect Wednesday, Aug. 10. According to the Colorado Department of Healthcare Policy and Financing, the bill “includes provisions to incentivize hospital compliance by prohibiting a hospital from initiating a collection action against a patient if the hospital is not in material compliance with the federal regulations. The state legislation also gives consumers who have been sent to collections the power to sue the hospital if they believe the hospital was not in material compliance with the federal regulations.”
A spokesperson for the Colorado Department of Healthcare Policy and Financing said the state will use hospital price data to create a price comparison tool for purchasers and consumers but did not say when the tool will become active.
Centura Health, which owns many of the hospitals accused by PRA of noncompliance, told the Problem Solvers:
At Centura Health, we are focused on helping our patients and consumers understand the cost of health care when it is received from a Centura provider. We encourage our patients to request a patient-specific price estimate to help them determine their costs. Additionally, Centura Health and our 19 hospitals are compliant with federal law regarding price transparency. To ensure transparency, we conduct frequent audits and analysis to ensure our ongoing compliance, including the use of the Hospital Price Transparency Final Rule Quick Reference Checklist as published by Centers for Medicare & Medicaid Services (CMS), which is the governing body on this subject. Our patients are our top priority, and we will continue to seek new opportunities to provide easier access to the cost of care.
Centura Health
FOX31 also received a statement from HCA HealthONE:
The federal regulations require hospitals to post a shoppable, consumer-friendly list of services or a price estimator tool, and provide a machine-readable file containing five types of ‘standard charges.’ Over the last year, we have worked diligently and have completed our implementation of these requirements. Our hospital websites have a consumer-friendly Patient Payment Estimator tool that provides relevant information to help patients understand what their out-of-pocket costs may be for hospital care, including those who are uninsured. In addition, we have posted contracted rates with third-party payers using one of the machine-readable file formats listed in the regulations to provide the five types of ‘standard charges.’
HCA HealthONE
UCHealth also sent FOX31 the following statement:
UCHealth is dedicated to price transparency, and we were one of the first systems in the nation to provide an accurate and easy-to-use billing estimates tool for our patients.
We believe we are in full compliance with CMS price transparency rules, and we have made this information easy to access through our website. When I looked today, the deidentified minimums and maximums are clearly listed along with the insurance carriers with which we are contracted. In fact, the format and posting of our transparency information is virtually unchanged from last year when the Patient Rights Advocate group named us the only hospital in Colorado to be fully compliant. We have not reduced or removed any information. It is important to note that only CMS has the final authority to decide whether hospitals are in compliance with their requirement.
While the CMS-required transparency information is readily available, we encourage patients to use our billing estimates tool. Available through our app, website, and a dedicated call center, this option will take into account a patient’s insurance plan, and how much of their deductible and out-of-pocket maximum a patient has reached during the current plan year to provide an accurate estimate of their personal responsibility.
UCHealth