Health Care Reality – You don’t have any privacy and there really isn’t any such thing as transparency.
Your mail boxes are littered with privacy notices from your doctor, your insurance agent, and every enterprise that you have ever done business with, such as the banks and credit card companies. And you are eventually alerted, about six months after the fact, when they get hacked. Heck, they even throw in some free credit monitoring. The federal government is worried about the manila folders in my file room while Home Depot gives up information from 53 million Americans. And that is still less than the hacked Anthem database that included 78.8 million people.
Transparency would appear to be an easier problem to solve. After all, how hard is it to answer a simple question like, “How much does this test cost?” In truth, damn near impossible!
A recent article in the Kaiser Health News detailed, the new Trump administration mandated hospital pricing lists are hardly useful. The article discusses the difficulty someone would encounter in trying to determine how much an anticipated hospital stay would cost. There is no point in trying to price out an emergency. But, there are plenty of planned visits to the hospital. Wouldn’t it be nice to choose the most cost effective place to receive care?
So let’s start with the most important fact – None of these posted prices are real. These are the chargemaster rates, the rack rate, the price that the self-insured and uninsured would be charged. You are normally billed the negotiated fee, the price your insurer and the provided have negotiated. This contractual amount will often be a percent of the chargemaster rate and vary by insurer and/or institution. So, the number on the chart isn’t the number you will be charged. Worse, the pricing is per service, supply, and facility. An operation may include a charge for a number of rooms – operating, recovery, semi-private or private hospital room, plus, in certain hospitals, a facility fee just to walk into the building a breath the air. Doctors, sutures, and saline are all extra.
In honor of the administration attempting to do something positive, even if it is at best baby steps, I thought that we could look at one procedure, from one group of hospitals, just to get some idea of how this all works. I went to the Cleveland Clinic website and spent ten minutes trying to find anything. I will save you some time. The key word is “price”. Not “prices”. That will take you somewhere else. Below is the listed price, per facility, for a labor and delivery charge for one baby. There are different charges for twins, etc… “The following list does not include charges for anesthesia, drugs, or supplies required for a particular delivery room procedure. Fees for physician services or anesthesia administration are also not reflected, and will be billed separately by your physician.”
Remember, these are all hospitals within the same system:
- Akron General – $4,585
- Avon Hospital – N/A*
- Cleveland Clinic – N/A*
- Euclid Hospital – N/A*
- Fairview Hospital – $2,828
- Hillcrest Hospital – $2,370
- Lodi Hospital – No mention
- Lutheran Hospital – N/A*
- Marymount Hospital – N/A
- Medina Hospital – No mention
- South Pointe Hospital – N/A*
- Union Hospital – $95.25 per hour
* N/A is really what they have posted as if there are no labor and delivery services available in these hospitals!
What do we learn from the price lists? Well, regardless of other services, if you can run in, give birth, and leave in 7 hours, Kate Middleton style, you should visit Union Hospital. Otherwise, not much. As their disclaimer states, this doesn’t include doctors, anesthesia, or even a chair for the father. We have to start somewhere. And this is what baby steps looks like.
Picture – Baby Steps – David L Cunix