CLEVELAND — Starting Jan. 1 every hospital in the country will be required to list prices for procedures and services as part of a new federal rule.
It is called the Inpatient Prospective Payment System rule and will also require hospitals to make medical records more easily accessible by patients.
The goal is to increase transparency and competition, but some patient advocates worry it may cause confusion since listed prices are rarely what patients actually pay out of pocket.
Many Cleveland-area hospitals have had general pricing listed for the last 2 years, as part of complying with Ohio state law.
Sharona Hoffman is the co-director of the Law-Medicine Center at Case Western Reserve University. She said while increased transparency is always a positive step, there are questions about how much this could drive medial care.
“So are hospitals going to have an incentive to make their prices look very low, are they going to start using cheaper devices in surgeries?” Hoffman asked.
And what a patient actually pays largely depends on a variety of factors — your insurance policy, deductibles, co-pays, even the time of year — which makes the posted sticker price of a procedure fairly unhelpful.
But for some, Hoffman said, the posted prices could provide valuable information.
“Because in some cases the price is pretty standard for very routine procedures and you’ll at least be able to tell well, this hospital seems to have higher prices overall, this hospital seems to have lower prices,” Hoffman said. “In some cases, the prices do vary quite dramatically so you might be able to make some educated choices about where to get care.”
But with that said, patients will have to keep in mind which hospitals are “in network” with their insurance policy, regardless of posted pricing. The best advice is to call your insurance provider to talk through what your out-of-pocket cost will be.
Below is information for Cleveland area hospitals regarding posted pricing.
“Since late 2016, Cleveland Clinic has made estimates for care available to patients when scheduling surgical and diagnostic services and upon request for all other services.
We have fully complied with the CMS requirement by posting our comprehensive hospital charges list on our website. Most patients do not pay these rates as their specific healthcare plan coverage determines any out-of-pocket charges.
Our financial advocates are available to help patients understand and calculate their potential financial obligations before they receive care. An online estimation tool is also available on our website. We also provide financial assistance to patients who qualify.”
More information can be found on here and here.
"In compliance with state law, UH Cleveland Medical Center is providing this price list containing our charges for room and board, emergency department, operating room, delivery, physical therapy and other procedures. The hospital's charges are the same for all patients, but a patient's responsibility may vary, depending on payment plans negotiated with individual health insurers. Uninsured or under-insured patients should consult with our admitting and billing staff to determine whether they qualify for discounts. These prices are correct as of January 1, 2018."
More information can be found here.
METROHEALTH MEDICAL CENTER
"MetroHealth embraces accountability and transparency in health care pricing. We have traditionally posted the pricing of frequently used services on our website, and starting January 1, we will list hospital charges for each inpatient and outpatient service or item provided by our System, per the new CMS rule.
A hospital’s charge is the dollar amount that is billed to insurance companies, however is typically not what a patient will be responsible for paying. A patient’s individual financial responsibility will vary depending on their type of insurance coverage and benefits."
We have representatives who can help assist with providing patients with out of pocket estimates and also financial coordination, whether you have insurance or not. For help, please call 216-778-3010. A link to the patient tool for cost estimation can be found here.