Hospital price transparency still a work in progress, consumer advocacy group finds
AMA: U.S. spent $4.5 trillion in healthcare in 2022
Maribeth Guarino, a healthcare advocate with the US PIRG Education Fund, said patients should be able to get an accurate look at what the price of care is before they see a doctor.
It is why she wrote PIRG’s “Post the Price” report.
“Patients, as consumers, have a lot of power over purse strings and the power of the consumer to decide where to spend their healthcare dollars,” Guarino said. “But they can’t do that if they don’t know the price.”
Since 2021, federal rules from the Centers for Medicare and Medicaid Service (CMS) require hospitals to make their prices public in two ways: a machine-readable file for researchers and a “consumer friendly” format as a price estimator.
PIRG found that, three years later, healthcare comparison shopping still isn’t easy.
“It’s iffy, honestly,” Guarino said. “We expected to be able to compare prices that were reliable, and unfortunately, there were some hospitals that weren’t even providing prices for procedures that we know they offer.”
Guarino and her team at PIRG looked for prices for a knee replacement surgery at 27 hospitals in the Cleveland, Ohio metro area.
“We found a huge variation in prices when it came to the cash price, and a smaller but still significant variation when it came to the insured price,” she reported.
InvestigateTV also analyzed hospital prices, spending months trying to find price information at 74 of the nation’s largest hospitals.
Of those, 77% had a tool designed to help patients determine hospital costs, as well as a comprehensive price list.
Guarino said they have seen improvement in the sharing of prices, but PIRG remains dedicated to monitoring both the accessibility and accuracy of information.
In the meantime, she urged patients to advocate for themselves:
- If paying with cash or without insurance, patients can request a “good faith estimate” before receiving services.
- If a final bill is $400 or more than the estimate, patients are entitled to dispute it.
- Insured patients can also ask their insurance company how much the procedure will cost out of pocket.
“I think the more that we use these tools, the more that we ask hospitals for prices,” Guarino shared. “The more likely we are going to move closer to accurate prices.”
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