While the Trump administration pushes for a rule to require hospitals to disclose the prices of their procedures, Maryland and some other states already have some initiatives to let patients compare prices across hospitals.
The federal Centers for Medicare and Medicaid Services issued last month a proposed rule that would require hospitals to disclose to patients what their estimated out-of-pocket costs would be for a procedure and to disclose rates for in-network providers and allowed amounts paid for out-of-network providers.
Maryland’s programs may offer some clues as to what can work and not work about the Trump proposal aimed at bringing down prices through market competition.
What the proposal is missing is some sort of quality measure at the same time, said Ben Steffen, executive director of the Maryland Health Care Commission, which publishes expected hospital rates in Maryland.
The commission publishes prices showing prices paid by Medicare and private payers. Another website the commission publishes, Wear the Cost, includes quality information and a simplified total price that includes things like imaging, tests and rehabilitation.
“By requiring institutions to post information, that in itself is probably not going to help consumers make the consumers very easily if they want to shop around,” Steffen said. “I think what will gain the most traction is if we link cost and quality together, and much of our focus has been on trying to do that.”
The Wear the Cost website lists prices for hip replacement surgery, knee replacement surgery, hysterectomy and vaginal delivery. Steffen expects the site to expand this spring.
It is also different from the federal proposal in that it offers information collected and published by a state agency. That information is posted in a patient-friendly way rather than using specific procedure terms or codes.
Other states to publish hospital prices include Iowa, Maine, Massachusetts, New Hampshire, Texas, Virginia and Washington.
The American Hospitals Association filed a lawsuit Wednesday to block the proposed Trump rule.
Hospitals have complained that the proposed federal rules would be anti-competitive, releasing publicly rates that they negotiate with insurance companies. They also said that releasing the prices would confuse patients.
“Instead of giving patients relevant information about costs, this rule will lead to widespread confusion and even more consolidation in the commercial health insurance industry,” Rick Pollack, president and CEO of the hospital association, said in a statement.
In Maryland, those rates are disclosed and set by a state commission, not through negotiations between different insurance carriers and the hospitals.
The state hospital association drew a sharp line between what the state does with data and what the federal rule proposes.
“The state’s hospitals and health systems support transparency efforts, when done right,” Bob Atlas, president and CEO of the Maryland Hospital Association, said in a statement. “Maryland hospitals do not negotiate their rates, they are set by a state agency, so the impact of the flawed federal rule will be minimal. We encourage efforts at the state and federal level that shine a light on the complete picture of consumer cost exposure, of which a hospital charge is just one part.”
What patients can expect to pay for a hospital procedure does encompass more than just what the hospital charges. In the example of a knee replacement, Wear the Cost says patients can expect to pay for things like tests, surgery, pharmacy costs, nursing care after surgery, doctor visits after discharge, physical therapy, home health visits and crutches.
But there can also be unexpected charges that result from complications due to the procedure, which is where Steffen says looking at quality and outcomes for previous patients is important.
“I think that you are only getting a part of the picture if you post only cost information,” he said. “I think some additional effort needs to be made on quality as well.”