Toledo area hospitals quick to comply with federal transparency rule

July 5 – Local hospitals are cooperating with a federal rule put in place during the Trump administration to bring Americans more transparency into health care costs, an analysis by Blade found.

This is in stark contrast to what is happening nationwide, according to a recent study by the University of Minnesota that found that only one in four hospitals in the United States has fully disclosed the data required by the order.

In 2019, former President Donald Trump introduced the order to force hospitals to disclose negotiated rates with insurers or to pay a fine of $ 300 per day. The order went into effect on January 1, after being upheld by the District of Columbia Court of Appeals on December 29, 2020.

But more than five months later, a study polling 470 US hospitals found that the majority were slow to release detailed information about the fees they charge for services.

On site, ProMedica, Mercy Health, the University of Toledo Medical Center, and McLaren St. Luke’s Hospital provide patients with detailed information required by prescription in a machine-readable format that makes it easy for researchers and policy makers to analyze the information . found the blade analysis.

Tom Ealey, an economics professor at Alma College who grew up in northwest Ohio and studied hospital business practices extensively, said the difference in attendance in the United States was simply due to the hospital’s not-for-profit or for-profit label could.

“In the Toledo market, which is still 100 percent non-profit, I think you will get fairer prices and more transparency,” he said. “But obviously not all hospital systems are non-profit, and they vary in their policies, procedures, and billing.”

Mr. Ealey argues that because of the complexity of the American healthcare system, small attempts at transparency – like this federal rule – tend to have minimal impact.

“The US healthcare system is so complicated and so inefficient that no one would ever develop one,” he said. “I think this will have a negligible impact on lowering prices. In essence, we have built a system that is so complex and inefficient that it is too complex and inefficient to reform meaningfully.”

The story goes on

“Controlling costs,” joked Mr. Ealey, “is like hugging an elephant.”

Dr. Johnathon Ross, a local doctor who is president of the Lucas County Board of Health and who has long criticized the American healthcare system and its complicated prices, agrees.

“I don’t think it’s going to matter much,” he said of the hospital price transparency rule, which he believes appears in mind-boggling spreadsheets with tens of thousands of columns and codes unfamiliar to the average person outside the industry.

“I think you could try and get outside experts to try and look at this huge price list and help people get a better deal,” he said. “… With this idea of ​​bundling payments around certain non-urgent, non-urgent services, you can probably make some cost savings, but it will never be enough to deal with the weirdness we have, which is financial complexity.

“Most hospitals now have more accounting clerks than beds,” added Dr. Ross added.

Jean Abraham, a professor of health administration in the University of Minnesota’s School of Public Health, said although the results suggest limited use of the early data for consumers and researchers, reporting could improve over time.

“It is very difficult for consumers to know what price to pay for treatment in a hospital,” she said. “The goal of the requirement is to enable consumers to make better informed decisions about their health care based on pricing information.”

The University of Minnesota study, published in the journal Medical Care Research and Review, found that while relatively few hospitals reported their negotiated rates with insurers, nearly three-quarters published a subset of the rates in a consumer-friendly format.

The reason could be that hospitals could have opted out of reporting negotiated tariffs because they were busy dealing with the coronavirus pandemic in 2020, researchers wrote, and because the hospital industry is challenging the rule in court. The penalty of just $ 300 a day doesn’t strongly convince even larger health systems to abide by the rule, Ealey said.

“The fine is $ 300 a day,” he said. “… It’s easier for a lot of for-profit companies to pay the $ 300 a day.”

About three in five Americans have private health insurance. Spending by the privately insured has increased 50 percent over the past decade, researchers wrote, in large part due to price increases for services billed by health care providers.

Prices are set through negotiations between insurers and hospitals, which leads to dramatic fluctuations.

Information from The Blade’s intelligence services was used in this report.

First published July 5, 2021, 10:00 a.m.

Comments are closed.