In my last post, I discussed the push for increased price transparency in health care, and why transparency is good for consumers. For example, if you need a knee replacement, you should be able visit your local hospitals’ websites, find a price estimate for the surgery at each hospital, and make an informed decision about where to have the surgery done. I decided to try this out for my usual hospital of choice, Mercy Hospital in St. Louis. I used the online price estimation tool, and per Mercy’s suggestion searched “knee replacement.” Nothing came up:
I decided to try the same thing out at the flagship hospital for four of St. Louis’s major hospital systems. I found that the price without insurance for a knee replacement was $26,122 at Barnes Jewish and $18,766 at St. Luke’s. Using that search term in the pricing websites for both Mercy St. Louis and SSM Saint Louis University turned up no matches. I then decided to broaden my search to every hospital in Missouri.
I used the rules outlined by the Centers for Medicare and Medicaid Services (CMS) to evaluate how “transparent” each hospital’s pricing was. The rules state that each hospital needs to have a consumer-friendly way to shop for common services, as well as a comprehensive list of all services and charges in a digital file. I found that of Missouri’s 164 hospitals, only 47 fulfilled both requirements. That is a compliance rate of just 29%, which, considering the federal rule is a year and a half old, is pretty terrible.
Many of the 47 “compliant” hospitals, such as Mercy, had some sort of online form to estimate prices but, in my opinion, did not make the system all that easy or intuitive to use. Many of these sites would not accept a general term for a procedure, like “knee replacement”, but instead required a technical procedure name or hospital code. Requiring the average patient to have such specific information is not “user friendly.” Likewise, the digital files many hospitals provided are difficult to read unless you have extensive computer software and coding knowledge. The digital file Mercy provided was one of these difficult file types. After spending approximately 45 minutes using code to read Mercy’s file, I found that it was still missing key information CMS requires about negotiated rates between the hospital and insurers.
The bottom line is that Missouri hospitals, by and large, are not following the plain intent of the rules, which makes it difficult for patients to know how much their care will cost and to effectively compare prices. If you would like to try to research the prices of procedures for yourself, I have included an Excel file at the bottom of this post that has URLs for every hospital’s pricing information.
