A federal mandate effective Jan. 1 requiring hospitals to post the list prices of services could be a first step towards transparency, but the New Jersey Hospital Association warns it may not actually do much.
Here’s why: The information isn’t the true price of the service. It’s more like the sticker price on a car — it’s a starting point.
The bill that a patient eventually receives reflects the negotiated rates with the insurer, or the charges that Medicare or Medicaid have agreed to.
In New Jersey, only about 5 percent of health care services are ever paid at the list price, according to NJHA spokeswoman Kerry McKean Kelly.
“We know this doesn’t make much sense for consumers, but there really aren’t standard hospital prices in our health care system, with government plans like Medicare and Medicaid dictating the rates they will pay, and insurance plans negotiating lower rates,” Kelly said. “For those with insurance, the best source for price information and out-of-pocket costs is their insurance plan. We also urge consumers to contact their hospital directly if they have questions, although the hospital oftentimes will not know all the details of a person’s specific insurance coverage.”
In addition, the new rule is not really new. Hospitals have for years been sharing some information from the list of prices, known as a chargemaster.
NJHA has had a collection of that information posted on its site for the past 11 years at www.njhospitalpricecompare.com. The prices are updated to 2016, and will be updated with 2017 numbers next year.
The Affordable Care Act also required some transparency, by asking hospitals to post information on their website to let patients know they can ask for the chargemaster at any time.
But, because the actual cost to a patient comes from the insurers, Kelly said it’s best to speak to the insurance company when inquiring about charges.
So, while the posting of the full, searchable chargemaster is something new, it’s only a step in the direction of true transparency.
“It’s a step forward, but it doesn’t solve the issue for patients and consumers in making the information easy to use,” Kelly said.
But this is a step in the direction of encouraging more consumerism in health care, and the more patients demand meaningful information to make health care decisions, the more the system will have to do to respond to the demand.
For now, the answer to pinpoint costs remains in the hands of the insurers.
“If you have insurance, talk to your insurance company, because they know better what you will (pay),” Kelly said.