Effective January 1, 2019, the Kiowa County Hospital District has posted the charges for items and services for both the hospital and the clinic on the website. That information can be found at www.kchd.org.
However, one caveat before going to the website: do not expect it to resemble what most people might describe as a price list. Does it contain the information that is required? Absolutely. Does the executive staff at KCHD endorse transparency? Yes, that’s why their door(s) are always open. Does it reflect the hospital’s willingness to list the charges for items and services available? Again, absolutely. Does it further reflect the hospital’s willingness to explain to patients any and all charges that appear on their bill? Again, absolutely yes. Anyone who has ever asked the staff in the insurance department can testify that any questions asked will be answered both in depth and accurately.
The reason the hospital price list does not look like…a price list…is distinctly related to the complexities of the very health care system that is demanding the transparency the price list is supposed to reflect.
Let’s go back a few years.
Since the Obama administration and the increased public attention paid to healthcare in America, there has been a move for a greater degree of patient involvement and empowerment when it comes to different aspects of their medical care. One of the more challenging areas has been specifically related to patients becoming informed about the cost of that healthcare itself.
In recent years, some groups have advocated for hospitals to make public the amount they charge for items and services. This has resulted in, among other things, patients becoming accustomed to seeing charges spelled out in great detail on their bills. That’s good news. Anyone who recalls the “old” bills knows how frustrating it can be to see what was actually done, let alone how much it cost.
However, even more recently, there has been increased pressure for that information to be listed in a format viewable by the public at large that is also easily printed out on a computer.
Historically, for their part, some hospitals and doctors have demonstrated some reluctance to publically disclose all costs, due in part to the complexity involved in situations where additional costs might not be reflected on a “price list” but would become a factor if complications arose during a procedure.
In other words, advocates of open and transparent pricing described a situation where a patient needing to have his gall bladder removed could (hypothetically) go to one hospital website after another and find the least expensive place to have the surgery performed. That would be great if gall bladder surgery were as formulaic as…oh…changing the oil in a late model car. But the human body isn’t like a car engine. Granted, some gall bladder surgeries are somewhat formulaic. Some but not all. In other words, docs and hospitals were concerned that Patient Jones may see (and ultimately pay) $X to have his gall bladder removed but Patient Smith may need the same procedure—may even go to the same hospital where he’s operated on by the same doctor—but will end up with a bill for $X + $Y + $Z because of unforeseen complications during surgery.
Nonetheless, effective with a rule passed last April that was implemented on January 1, 2019, hospitals across the country are now required to list their prices on the internet for public availability. The rule was generated out of the Centers for Medicare and Medicaid Services (CMS) and will primarily apply to Medicare. However, as time progresses and the move for transparency picks up more advocates, officials with CMS expect it to have an influence on healthcare practices across the nation.
As stated by Veema Serma, head of U.S. Centers for Medicare and Medicaid Services and originator of the rule, in a recent interview with Associated Press, “We are just beginning on price transparency. We know hospitals have this information, and we want them to post it for the public to see.”
While many organizations, including the American Hospital Association and the Colorado Hospital Association, are in support of the intent of the ruling, the general consensus is that the CMS requirement calling for prices to be posted as outlined in this most recent ruling may still not reflect the actual amount most patients pay for services and items.
Again, this is a result of the complexity involved in the payment system and is largely due to the different rates negotiated by insurers and the government as well as how much of the charge will be paid by one of those two entities as part of their coverage. Framed another way, in an industry with over 1500 operating insurance companies, many of whom compensate at varying levels and offer varied benefits packages plus health care providers who are, by nature of their profession, inclined to individualize treatment of patients depending upon different circumstances and concerns, the notion that a patient will be able to go to a hospital’s website and, based upon prices listed, predict what a procedure will cost with guaranteed accuracy is something that is not in the foreseeable future.
Suffice it to say, the system—and related requirements—continues to evolve with an emphasis on compliance on transparency. Not only are hospitals required to list their prices on January 2019, they will be required to list new prices in January of 2020. Failure to do so will result in a fine.
Enabling patients to review price lists can provide him or her with at least a baseline knowledge of the costs involved in a procedure. And that’s a good thing. Knowledge leads to empowerment, and an empowered patient is an integral component of a dynamic and successful health care system.
Meanwhile, for patients (current and prospective) of KCHD and the Eads Medical Clinic, there are prices listed for services and items. However, a much better approach to getting a clear reading of what charges may involve would be to first contact your insurance company to find out what is covered under your policy. If anyone still has questions, the staff at KCHD are always ready and willing to answer any questions people may have.
Questions related to specific costs and charges should be addressed to the KCHD insurance staff. They may be reached at 719-438-5401.