Dr. Josh Taylor, a family medicine doctor with the Centura Health Physician Group, examines a patient. Courtesy Centura Health/Justin LeVett

Health-care pricing remains opaque

Dr. David Donahue, a general surgeon
Dr. David Donahue, a general surgeon, connects with a patient at Longmont United Hospital.

A new law enacted in January is the latest in a decade-long effort by Colorado legislators to generate more transparency in health-care pricing.

The Transparency in Health Care Prices Act, co-sponsored by state Sen. Kevin Lundberg (R-Berthoud) and state Rep. Susan Lontine (D-Denver), focuses on making it easier for people without health insurance, called self-payers, to find prices for procedures at providers in their communities.

Self-payer pricing was not addressed in legislation passed in 2008 to provide more information on medical-procedure pricing. That year, the Colorado Legislature passed a law requiring the commissioner of the Division of Insurance to develop a website that discloses pricing information for health-insurance plans reporting their average reimbursement rates. The Legislature also passed a law requiring the Colorado Hospital Association to post hospitals’ average billed charges whether covered by insurance or not.

Five major providers in the Boulder Valley and Northern Colorado — UCHealth, Banner Health, Centura Health, SCL Health and Boulder Community Health, representing 12 hospitals and myriad clinics in the region  — have boarded the transparency train, posting prices they all say comply with the law, and many of them had prices posted well before the Jan. 1 deadline.

Self-payers make up less than 10 percent of the state’s population, but it is a group that could be increasing in numbers with the repeal of Obamacare’s mandate for everyone to have insurance or pay a penalty. The percent of self-payers in Weld County is 9.6 percent; Boulder and Broomfield counties, 7.4 percent, and in Larimer County, 4.5 percent, according to a 2017 survey from the Colorado Health Institute.

The self-payer segment accounts for a small percentage of patients at hospitals. For example, UCHealth spokesman Dan Weaver said self-pay patients make up 2 percent of UCHealth patients and generate about 0.2 percent of its revenue. UCHealth operates four hospitals and several clinics in the region. Dr. Robert Vissers, president and chief executive of Boulder Community Health, which has one hospital, said self-payers make up 3 percent of its patients.

Complications and pricing

The new law acknowledges that health-care providers must charge more for a procedure if a patient encounters complications, and it doesn’t require a hospital to list physician fees for a procedure, which makes up a large portion of a bill.

For example, Centura Health points out the prices on its website for self-payers don’t include complicating factors or professional fees for services provided by a physician, surgeon, pathologist, anesthesiologist, radiologist, nurse practitioner or other independent practitioners. They do not include fees associated with implants, high-cost drugs or second procedures.

Nor is there a mechanism in place to monitor a provider’s compliance with the law. Mark Salley, communications director for the Colorado Department of Public Health and Environment, said health-care professionals and facilities are not required to submit their health-care prices to any government agency for review or approval.

“The law lays out no penalties and states CDPHE cannot do anything related to enforcement,” Salley said.

And, the law does not require uniformity in reporting. It provides guidelines that lead to ambiguity: the law says a provider needs to list its most commonly diagnosed procedure —  which varies from provider to provider —  and suggests several different ways of determining the price.

Some providers list median prices, some average prices and some list a price range that can span up to tens of thousands of dollars. If self-payers want to take the time to visit all health-providers’ sites to do some comparison shopping, they basically are out of luck.

Also, language describing a procedure varies. For example, one provider calls fluid in the lungs a pulmonary edema, another calls it fluid gathering in the lungs. The different names could lead someone to wonder if it is the same condition. Some procedures carry names that are understood only by physicians and administrators, such as “ESOPHAGITIS GASTROENT MISC DIGEST DISORDERS W/O MCC, far from what Lundberg was hoping to achieve when he urged the use of “plain English.”

Vissers said the law may not achieve all its goals, but he is supportive of the effort, calling is “a good early step.”

Julie Lonborg, the Colorado Hospital Association’s vice president of communication and media relations, said the most recently enacted law was designed to give patients, or self-payers, within a community a view of charges for a hospital’s most common procedures.

“This bill wasn’t designed to provide consumers a review of prices across all hospitals for the same service,” she said. “There is already a tool that does that as required by legislation passed in 2008.”

That report, called the Hospital Price Report, is on the CHA’s website at cha.fhsclearquote.com. Users can select a hospital, or hospitals, and then a procedure from a drop down menu to see an average charge as well as average length of stay in the hospital for a particular procedure.

Mystery and confusion

Mystery and confusion surrounds any attempt to glean a fixed price for a procedure because each procedure can take a turn on the operating table requiring additional  resources to treat a patient. Because of that, hospital administrators say it’s impossible to set fixed prices.

UCHealth’s Weaver said the law requiring providers to post prices could add to an already confusing landscape.

“Because of the complexity of pricing, it’s possible the self-pay prices we have posted on our website might increase confusion,” Weaver said. “UCHealth supports greater transparency and sharing more information about prices with patients. However, I think estimates can best be provided on an individual basis with patients so that specifics like a patient’s copayment, coinsurance, deductible, out-of-pocket maximum and eligibility for financial assistance can be evaluated.”

BCH’s Vissers said the best path to understanding what a procedure is going to cost is for patients to have that discussion with their primary-care physician. Vissers said the doctor and patient can discuss who might be the best provider or which location might be best-suited for a specific medical service. Armed with information from the primary-care physician, patients can check with their insurance companies regarding their specific financial responsibility, he said.

Many hospitals provide their own financial-assistance programs to aid those who qualify. But hospitals try to make it clear on their websites that patients should ask about their programs.

The law requests the pre-discounted price. Some hospitals post prices with a discount already included.

The value factor

Administrators believe that level of quality their hospitals provide should be a key factor in choosing a hospital or physician, not just a price, but value is something that is not easily quantified.

“Factors such as third-party accreditations or enhanced ability to care for higher acuity cases in addition to pricing information can help ensure that a person gets the best possible care for their health needs, said Britta Robinson, communications manager for Good Samaritan Medical Center in Lafayette.

Mark Carley, vice president of managed care and payor relations for Centura Health, said the hospital system is on board the transparency train.

“We support the state’s efforts and believe our transparency strategy addresses the key components of the bill and more. …  Part of our efforts include evolving our transparency strategies to provide consumers with meaningful information that helps to inform their decision on where to receive care.”

Added work for staffers

In complying with the law, hospitals generally have asked existing employees to generate the lists for their websites.

Rich Sheehan, a spokesman for BCH, said it took six employees about 20 hours to make the initial list, but it’s unclear what the cost will be to maintain the site.

Sara Quale, public relations director for Banner Health, said the health system operates five hospitals in Colorado along with many physician clinics and ambulatory surgery centers.

“Each required separate listings, and that was a significant undertaking,” she said. Banner created a team of employees from finance, information technology, public relations and government relations to work on the project.

Hospitals’ staffs for the past 10 years have been gathering data on prices charged to patients per procedure and supplying it to the Colorado Hospital Association for its pricing website.

Lonborg said the association’s data-analyst staff converts the raw data from hospitals to a comparison chart on its website. She said new prices are posted once a year, generally in July, that reflect prices charged during the previous year. Many hospitals are voluntarily providing the CHA with emergency room prices, and some are also providing that information on their websites, information not required by the latest law.

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Online links for procedure price charts

Below is a list of the 12 major hospitals serving the Boulder Valley and Northern Colorado with links to their websites that contain prices for their most commonly diagnosed procedures. The prices listed are only for self-payers — people without health-care insurance. The postings are in response to the Transparency in Health Care Prices Act passed in 2017 by the Colorado State Legislature that went into effect Jan. 1, 2018.

 

Independents
Boulder Community Foothills Hospital – Boulder

www.bch.org/documents/Pay-My-Bill/BCH-Price-Transparency-2017.pdf

 

Banner Health
Fort Collins Medical Center –  Fort Collins

McKee Medical Center – Loveland

North Colorado Medical Center – Greeley

www.bannerhealth.com/patients/billing/direct-pay-prices/colorado-health-care-prices

 

Centura Health
Avista Adventist Hospital – Louisville

Longmont United Hospital – Longmont

www.centura.org/patients-and-families/pricing/costs-common-procedures

 

SCL Health
Good Samaritan Medical Center – Lafayette

Platte Valley Medical Center – Brighton

www.sclhealth.org/locations/good-samaritan-medical-center/patients-visitors/understanding-medical-costs-fr/

 

UCHealth
Broomfield Hospital – Broomfield

Longs Peak Hospital – Longmont

Medical Center of the Rockies – Loveland

Poudre Valley Hospital – Fort Collins

www.uchealth.org/billing-and-pricing-information/uninsured-patients/

 

Colorado Hospital Association
The association posts hospitals’ average billed charges whether covered by insurance or not at
Cha.fhsclearquote.com

 

Colorado Division of Insurance
The division of insurance maintains a website that discloses health-care pricing information for health-insurance plans reporting their average reimbursement rates at
doraapps.state.co.us/insurance/drg/Default.aspx

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See additional health care stories from BizWest’s March 2018 edition:

BCH integrates behavioral, physical health

Good Sam treatment targets liver cancer

Community colleges seek to add BSN degree

Legislature serves up health-care solutions


 

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