Last month, the federal government revealed that the United States was spending $4.1 trillion on health care in 2020, over 20% of GDP and twice the developed world average. While hundreds of billions of dollars have been spent fighting Covid-19, much of it has gone to support the country’s broken health care system. National healthcare spending has doubled, adjusted for inflation, since 2000.
New research by PatientRightsAdvocate.org finds excessive and arbitrary hospital prices, which can vary tenfold depending on payer or hospital, burden consumers in the Los Angeles area. Our findings reinforce the need for US Health and Human Services, led by Secretary Xavier Becerra, to vigorously enforce its hospital pricing transparency rules. Doing so will allow patients to protect themselves from price gouging and empower them to take control of their medical financial decisions.
Hospitals are currently blinding consumers, including patients, employers and unions, to pricing, then blinding them with huge bills weekly and monthly thereafter. This price uncertainty allows hospitals to overcharge, waste and disparate prices for the same care – even in the same hospital. This status quo is responsible for 20% of Californians with problematic or unrepayable medical debt.
To remove the hospital price curtain, a federal price transparency rule went into effect last year that requires hospitals to disclose their discounted cash amounts and all confidential contract prices. Confidentiality according to the plan and the payer. With real prices, consumers can identify the highest quality care for the lowest possible price and enjoy substantial savings in healthcare. Unfortunately, this law has been marred by widespread non-compliance.
Our researchers recently examined the websites of the top 30 hospitals in the Los Angeles area by US News and World Report. We found pricing information accessible at only four: Cedars-Sinai Medical Center, Torrance Memorial Medical Center, Huntington Hospital, and Pomona Valley Hospital Medical Center. Yet even these limited price disclosures show how vulnerable Namland consumers are to the US healthcare system.
Consider the wild price swings at these hospitals for just one service: the standard outpatient non-contrast brain MRI (CPT code 70551 pays). The price of this treatment at Cedars-Sinai varies about tenfold depending on the payer, from $367 for the Blue Cross Blue Shield Medicare plan to $4,043 for the commercial Kaiser plan.
The price for consumers with Blue Cross HMO insurance is $2,162, roughly half the price of the Kaiser. This price does not include additional physician and facility fees payable by the patient.
The price of a brain MRI also varies widely between nearby hospitals. The disclosure prices show that Blue Cross HMO-insured patients at Torrance Memorial pay just $127 — 17 times less than Blue Cross HMO patients pay for the same scan at Cedars-Sinai, just 20 miles away. mile.
In other words, the price can be more than ten times different for the same service at the same hospital with different insurance coverage. And prices can be more than ten times different for the same service at different hospitals with the same coverage. Consumers lose one of two ways.
If you include the Medicaid price – Huntington Hospital lists the Los Angeles Medi-Cal plan price for this same brain MRI for just $39 – the price can change 100 times.
Pomona Valley lists a cash price for this procedure: just $450. This reasonable price raises the question: What good is it to pay thousands of dollars in health care premiums each month if hospitals charge Insured patient fees thousands of dollars higher than cash payers? Cigna price in Pomona Valley for the same treat: $6,500.
Cash-based independent MRI centers in Los Angeles offer brain MRIs for as low as $225 with no additional facility fees. This cash discount demonstrates how bureaucracy and profiteering in the healthcare industry has driven prices up.
Patients can protect themselves against such wild hospital price fluctuations and determine the best care at the best price when all hospitals adhere to price transparency laws and transparent pricing. clear.
The Biden administration implemented a new regulation on January 1, significantly increasing fines to more than $2 million per year for hospitals that break the law and fail to disclose their prices. Timely and robust enforcement of this regulation will encourage more hospitals to disclose prices to make it easier for consumers to protect their health and property.
When prices are known in advance, no patient or employer will pay ten times more for the same care in the same hospital than someone in the next room. Consumers, who are often willing to drive to save a few cents per gallon of gas, will inevitably drive to competing hospitals to save thousands of dollars on their health care.
Highly valued patients will open up a competitive, functional marketplace that will help reverse runaway healthcare spending and revolutionize American healthcare for generations to come.
Cynthia A. Fisher is a life sciences entrepreneur, founder and president of PatientRightsAdvocate.org, and founder and former CEO of ViaCord.
https://www.sbsun.com/2022/02/01/hospital-price-disclosures-reveal-prices-can-vary-by-ten-times/ Hospital price disclosure reveals possible tenfold difference – San Bernardino Sun