At Massachusetts General Hospital in Boston, an “HC BYP FEM-ANT TIBL PST TIBL PRONEAL ART/OTH DSTL” will run you $35,014.00. If you go to Vanderbilt University Medical Center in Nashville, an “HC ECMO/ECLS INIT VENO-VENOUS” costs $51,384.00. And at Bellevue Hospital Center in New York City, a “TRLUML PERIP ATHRC ILIAC ART” goes for $22,689.83.

These mysterious prices—and tens of thousands of others—are all on the hospitals’ respective new price lists, available in beastly spreadsheets downloadable from the hospitals’ websites. As of January 1, hospitals around the country are now federally required to list all standard charges for common treatments and care. The goal is to make hospital billing more transparent, allowing patients to comparison shop and anticipate medical expenses.

“This is about empowering patients,” Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said last week in a conference call with reporters.

But the price lists are less than helpful, to put it mildly.

For one thing, the itemized price lists can be hard, if not impossible, to interpret. Many of the entries include gibberish medical jargon and an alphabet soup of abbreviations, such as the examples above. But even if you can identify a procedure, device, or test that you’ll need during a hospital stay, you still might not be able to estimate a total bill because there will likely be multiple charges. And those charges can be difficult to anticipate. Hospital bills can include room stay, medications, and a constellation of other incidental and unpredictable expenses in addition to specific procedure charges.

Then, of course, is the matter of insurance rates and coverage. The fat sticker prices hospitals list can get trimmed significantly in negotiations with insurance providers. Then, depending on individual insurance plans (network coverage, deductibles, etc) the portion of a hospital bill that a patient pays can be dramatically different—and hard to estimate.

Apples and oranges

Still, comparing hospital price lists can help patients make informed choices, right? Nope. Each hospital lists prices differently. Some describe the same procedures with different abbreviations and jargon. Others have vague descriptors or generalized fees.

For instance, Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, lists the general price of surgeries by operating time, down to half-hour increments; surgeries that take between 24 and 24.5 hours cost $54,004 generally, while surgeries that last between 23.5 and 24 hours run $52,947, according their pricing guide.

George Washington University Hospital’s pricing guide includes maddeningly vague charges. One item, listed simply as “viral illness,” has a price estimate of $43,307.99. Another entry, listed as “headaches,” has a cost of $32,456.66, and a listing of just “seizures” is priced at $68,113.41.

“To 99 percent of the consuming public, these data will be of limited utility—meaningless,” Kenneth E. Raske, the president of the Greater New York Hospital Association, told The New York Times.

The prices even appear meaningless to the hospitals themselves. To view the lists, some hospital websites require visitors to agree to terms and conditions that state that prices are not guaranteed to be accurate, as well as subject to change and not reflective of patient bills.

As the Times noted, the requirement to list the prices is rooted in one sentence of the Affordable Care Act, which states that “Each hospital operating within the United States shall for each year establish (and update) and make public (in accordance with guidelines developed by the secretary) a list of the hospital’s standard charges for items and services provided by the hospital.”

Legal requirements

For years after the ACA passed, the government advised hospitals that they could fulfill their obligation by making estimates available to patients upon request. The Trump administration, however, stepped up the requirements, forcing hospitals to publish full lists. But the interpretation of “standard charges” was left up to hospitals and there is currently no enforcement for the requirement.  On many hospital websites, even finding the list can be difficult if not impossible.

In a November blog, Verma wrote, “We know this is just a first step,” adding that the government has “actively sought input on how we can make this data easier for patients to use.”

https://arstechnica.com/?p=1440893