Maine hospitals now posting prices for services

Reported in the Lewiston Sun Journal by Lindsay Tice

LEWISTON, ME — Mainers can now find the price of a hospital visit with a click, because of new federal rules, Mainers can now find the price of a hospital visit with a click.
However, experts warn the new costs posted online amount to sticker prices. Patients’ circumstances vary — including whether they have insurance coverage — so actual cost may be different from the list price.

The Centers for Medicare & Medicaid Services (CMS) began requiring hospitals to post prices Jan. 1. The postings must be easy to download and read, and they must include current charges for every service and item provided by the hospital, including medications.

Hospitals that do not follow through are at risk of being penalized by CMS, a large payer of medical care included Medicare.

Maine hospitals began posting charges on their websites this week.

Some price sheets are easier to find than others. They typically are available by going to the hospital’s website, clicking on “patient information” or “billing information” and finding “billing price estimates” or “pricing transparency” among the options.

Some price sheets are also easier to understand than others. 

With tens of thousands of items to list, hospitals abbreviated many procedures or medications, leading to listings such as the $1,191 “manip knee jnt w/anes, bilat” — a bilateral manipulation of knee joint with anesthesia — at Northern Light Eastern Maine Medical Center in Bangor.

“In the coming weeks, we plan to refine and simplify this information even further for our patients as we strongly believe health care should be accessible and straightforward,” Northern Light Health spokeswoman Rebecca Parent said of the hospital’s price sheet.

While hospitals must post their charge lists, CMS is encouraging them to add extra data, such as quality information and additional pricing information. Some Maine hospital leaders say they will post more.

“We fully support being transparent and empowering potential patients to make well-informed decisions about their health care,” said Steven Jorgensen, president of St. Mary’s Regional Medical Center in Lewiston. “We’ve posted hospital, procedure and pharmacy prices. In addition, to make this data more comprehensive yet still consumer-friendly, we expect to post bundle prices for a variety of standard procedures soon.”

This is the first time hospitals have been required to publicly post their full charge sheets online. However, Maine hospitals have been required by state law to provide some information to patients on request and have been required for years to send some cost information to the Maine Health Data Organization for its price comparison website: www.comparemaine.org.

Ann Woloson, executive director of Consumers for Affordable Health Care in Augusta, said she likes pointing patients to the CompareMaine site, but she believes this new comprehensive, hospital-by-hospital listing will be helpful, too.

“Any transparency with health care costs, especially hospital costs, is very important to Maine consumers who are paying more out of pocket for the health care they need,” she said. “Any information they can gain that reflects what their bottom line is going to be is obviously important.”

She cautioned, though, that a hospital’s list price may not reveal the full cost for a procedure. An anesthesiologist’s fee, for example, may be additional.

“It’s probably helpful to do a little bit more work,” she said. 

“Don’t just think that if you’re going to get a knee operation at some hospital that that price truly reflects all of the costs associated with it.”

At the same time, experts cautioned that hospitals are listing their sticker prices — the amount they charge to people who are uninsured or earn too much to qualify for charity care. The average patient typically pays a lot less after insurer-negotiated discounts and insurance coverage.

“Many patients are interested in their exposure to costs, which generally requires a conversation with their insurance company since that is who sets deductibles and co-pays and can provide patients the most up-to-date info on those cost factors,” said Jeff Austin, spokesman for the Maine Hospital Association.

“We encourage patients to speak to their providers and their carriers to get an estimate of costs.”

To make sure potential patients do not get scared by that list price, hospital officials encourage people to call their hospital’s billing department or other patient services department for more information about the listed procedures and their actual costs.

Where to find your hospital’s charge list:

Central Maine Healthcare (including Central Maine Medical Center in Lewiston, Rumford and Bridgton hospitals): https://www.cmhc.org/billing-and-financial-information/billing-price-estimates

MaineGeneral Medical Center, Augusta: https://www.mainegeneral.org/Pages/Appointments-and-Bill-Pay/Billing-and-Insurance.aspx

MaineHealth (including Franklin Memorial Hospital in Farmington, Stephens Memorial Hospital in Norway and Maine Medical Center in Portland): https://mainehealth.org/patients-visitors/billing-insurance/public-health-services-act

Northern Light Health (including Northern Light Eastern Maine Medical Center in Bangor): https://northernlighthealth.org/Locations/Eastern-Maine-Medical-Center/Patients-Visitors/Billing/Price-Transparency

St. Mary’s Regional Medical Center, Lewiston: https://www.stmarysmaine.com/patient-and-visitor-information/pricing/pricing-transparency

Physician echo - universally available quality care: from Naples Florida

This is a brilliantly written opinion from Dr. Allen Weiss, published in the Naples Daily News, in Florida.  Echo! "Transparent, objective and trustworthy quality metrics will drive America’s journey to universally excellent care and good health." ~ Allen Weiss M.D. 

Allen Weiss M.D. "Quality Care"

NAPLES, Fl - Quality matters. Better health for everyone should be America’s goal. Yet presently, where one lives and where one receives health care services can make a difference in outcomes.

Everyone — patients, families, physicians, non-physician practitioners, hospitals, health care systems and payers — should have access to the same objective information about the quality of health care services in their communities.

Accessible, transparent and comparative metrics will help move the country forward in addressing the perils of variability, consequently improving quality while lowering costs. According to the Dartmouth Atlas, a more than twofold variation in Medicare spending per capita in different regions of the country doesn’t necessarily equate with better quality or improved outcomes.

Objective comparison tools, although far from perfect, provide helpful information. The Centers for Medicare & Medicaid Services (CMS) Hospital Compare tool and its star-ratings system have been available since 2005. The easy-to-use website facilitates comparisons among hospitals based on nearly five dozen well-defined metrics.

This tool has dual benefits: assisting patients in choosing health care options and accelerating performance improvement because all can share best practices to improve health care delivery. While Hospital Compare has drawn criticism over its methodology and findings, over time CMS has responded with revisions. Such tools have value, even with their limitations.

CMS’ most recent hospital star ratings are based on seven major measures (mortality, safety, readmission, patient experience, effectiveness of care, timeliness of care and imaging) and 57 subcategories. Fair, transparent, timely and relevant scores easily understandable for patients, caregivers and payers are essential as our nation’s health care system strives to improve.

Health care is America’s largest industry, consuming 17.8 percent of gross domestic product at $3.2 trillion in 2016 and growing. U.S. health care perennially spends the most per capita yet also consistently ranks toward the bottom in outcomes among the 11 most-developed nations.

Better performance equates to fewer complications, decreased waste and lower costs. These attributes contribute to a healthier America.

Hospitals and health systems living off their past reputation and perceived greatness, embellished and polished by extensive marketing, no longer represent a rational, effective or even ethical business model.

Transparent objective metrics now make some of the most venerable institutions in the nation the most vulnerable.

Shopping for some services in health care is desirable given our consumer-centric society. But when people are sick and don’t have the luxury to check a hospital’s quality scores or prices, they shouldn’t have to worry about potentially receiving better care at the hospital across town.

Even more important, today’s hospitals and health systems should no longer see their core business as a health “repair shop.” 

Instead, we must look outside the four walls of our institutions, promoting wellness and prevention by focusing more on health rather than care.

Sadly, life expectancy has decreased for the second consecutive year, a first since 1963. Health care systems are viewed by the communities they serve as stewards of public health; we should be employing resources for socio-economic problems such as inequities of care, homelessness, hunger, violence, addiction, mental health and other maladies.

All members of the health care community have an obligation to be more responsive to customers. Sharing best practices among ourselves, just as we now share statistically accurate knowledge, will help everyone achieve better performance and outcomes.

Although the process may be uncomfortable initially, in the long run, having transparency as a stimulus for improvement will benefit every stakeholder. We can decrease the percentage of GDP devoted to sickness and hospitalization as we increase wellness and prevention.

Where one receives care matters greatly today. But let’s work to change that. Transparent, objective and trustworthy quality metrics will drive America’s journey to universally excellent care and good health.

Health Care continues to concern Americans- a Maine letter to the editor

"Letter to the editor" in a Maine newspaper calls for everyone to pay something for health care coverage. Although well intentioned, the author of the letter must realize how we already pay for health care coverage, whether or not we are the consumers. (Let's support a Medicare For All insurance program?)

Americans pay for health care coverage through revenue sharing to programs like:

1.  Department of Health and Human Services (DHHS) budgets funded by tax revenues.

• Medicaid assistance to children and the elderly in nursing homes
• Immunization and public health programs
• Health care research and disease prevention
• Grants for medical and nursing education programs
• CHIP- Childrens Health Insurance Program 

2.   By funding Veterans Health programs and providing access to care at Veterans Health Hospitals.

3.    By supporting the Centers for Medicare and Medicaid Services - CMS- where Medicare is administered.  

4.   By contributing to the payroll assessment matched by a contribution from employers to qualify for Medicare.

Moreover, Americans also pay privately for health care, whether or not we use it, when we are mandated to have automobile insurance whereby accident injuries are paid by the insurer.  

Home owners insurance provides health coverage for incidents allowable under the beneficiaries' personal injury provisions.

Workman's Compensation is a mandated program, whereby employee injuries, occurring on the job, are covered and paid at 100 percent without co-pays.

The above are just "top of mind examples" of how Americans already pay plenty for health care, and most of the time, we don't even use the coverage.  Unless we're on Medicaid, in a nursing home, a child who qualifies under CHIP or happen to be the unfortunate victim of an accident, we are already paying for health coverage, that we don't use.

What Americans need and we could all benefit from is taking every premium paid under the above plans and condensing the accumulated revenue into one big health care benefit fund.  

We can call it Universal Coverage or Medicare For All - or something else.  It doesn't matter,  because, in fact, by sharing the cost of all the health care we already fund but don't use, we could cover every man woman and child who qualify and probably lower our other insurance premium costs, in the process. Unfortunately, private insurance companies don't like the idea because it takes away premium payments to fund the universal health care provided. Too bad. Nevertheless, maybe insurance companies can figure out a way to receive tax credits for enabling universal health care to be made available to all Americans. 

Here is the text from the Letter to the Editor- although it is certainly a well intentioned opinion, I hope the author will come to realize how the ideas put forth are already included in his IRS bill. 

"Two basic principles should guide health care"

I would like to suggest that our elected officials take another crack a fixing health care, and in doing so adhere to two basic foundational principles.

1. Equal access to the health care for everyone. Access needs to be on a level playing field, not one where some have access to better or more comprehensive services than others. Factors such as employment, preexisting conditions or income should have no bearing on one’s access to health. Can we go so far as to say that access to health care services is a right, not a privilege?

2. Everyone pays. It’s true that some can afford to pay more than others, but everyone can and should pay something.

I believe that these are simple basic principles that everyone can agree to. They should not conflict with anyone’s political ideology be it conservative or liberal. I’ve heard people say that the issue of health care reform is complicated. I wouldn’t argue with that. What I would suggest though is that sometimes, simplicity can serve as a good foundation for building the solution to a complex problem.

Dennis Dalheim
From Wayne (Maine) published in the Central Maine Newspapers- KJournal