APPLETON - Hospitals are now required to post online what they charge for services and procedures,but what you see is not necessarily what you're going to get.
New rules from the Centers for Medicare & Medicaid Services, a federal agency within the U.S. Department of Health and Human Services, went into effect on Jan. 1 forcing hospitals to make a list of their current standard charges available.
The rules are in line with the Affordable Care Act's transparency efforts to help the public gain a better understanding of what they are paying for when it comes to health care.
While the publicly-listed charges help put a sticker price on items and services within the hospital, there are several factors that get in the way of knowing what a patient is actually going to pay out-of-pocket— one of them being individual insurance.
"Basically until you know A.)who your insurer is and B.) what benefit plans are, you can't find out what the price for a service is," said Marty Finkler, emeritus professor of economics at Lawrence University and local health policy advocate."I think you need to be able to ask 'what's the price for me given my insurance plan?'"
Insurance is onlyone of the factors to consider when you're reading the price list, formally called a "chargemaster."If you don't have a medical background, you mightnot be able to understand what you're looking at.
Chargemasters list the cost of medical services on a downloadable spreadsheet made up of thousands of lines of data labeled under medical billing codes. That can be confusing for someone outside the health care industry.
"It shows a level of transparency, but it's not all that useful,"Brian Potter, senior vice president of finance and chief operating officer for the Wisconsin Hospital Association said.
"We don’t think it adds much value to the consumer by looking at some kind of a spreadsheet with a bunch of codes and costs," Potter said."First of all, you'd have to understand what those codes meant, and second of all, you have to know how those codes apply."
The chargemasters also listeach individual item required within a patient's service, not the total costas a whole —meaning consumers have to know everything that's going into their care. If a patient requires care from a doctor, the charges for physician services are exempt from the list.
"It's almost like trying to buy a car by knowing what the price of a bolt and transmission costs," Potter said. "If you're having a knee replacement, you're going to have to know that you need a bottle of saline and an IV and all those kind of things. That's how granular the requirement is."
RELATED:Neenah trauma surgeon says gun violence is 'a major health care issue'
RELATED:5 tips for choosing a 2019 health plan during the enrollment period
Potter said the policy is not useful inWisconsin due to the state's efforts in health care transparency that have already been in place, including PricePoint, which allows consumers to go online and search the total estimated cost of a service instead of looking at each individual component.
"The CMS policy is more I guess for states that really don't have anything," Potter said. "It's kind of a weak start because it's not really consumer-friendly, but in Wisconsin we've gone much further ... transparency is very important, so it's nice that the CMS thing is bringing this issue back up, but their requirement right now is kind of confusing as to what the purpose of it is."
Philip Rocco, an assistant professor of political science at Marquette University, believes cost of hospital care is likely not the deciding factor when it comes to medical needs for most people.
"It's not even relevant," Rocco said. "People don't choose (hospitals) based on cost. Sometimes you go to the nearest hospital or if you are in a rural market, your choice is not really guided by who'sgot the best prices."
Rocco said quality of care is also an important factor to consider when looking at which hospital to go to for care.
"If consumers are choosing them based on price, they might neglect the number of readmissions ... that could be a patient safety (issue)," Rocco said.
JimDietsche, chief financial officer for Green Bay-based Bellin Health, believes the new regulations area positive move towardgreater transparency.
"What I see as overall beneficial is to bring more awareness and transparency to what things cost, what things are charged, so that ultimately patients or consumers will know what they're going to be charged for," Dietsche said. "What they really want to know is what is my out-of-pocket cost going to be when I come in for health care services and the law stops short of answering that question, but it's a step in the right direction."
