By Tom Still
MADISON, Wis. – Little-noticed by the public but a source of pain for most health systems was a Trump administration order in January that hospitals must post list prices for their services, in theory offering consumers more transparency and competitive choice.
The problem with the well-intended administration order is that “ChargeMaster,” the name for the federal price-listing system, is almost impossible for the average patient to navigate.
It contains data for thousands of medical procedures, but a consumer must be part physician and part electronic health records expert to understand it. No two hospitals seem to classify services the same way, the medical jargon varies and there’s no way for consumers to know if the “list price” for a specific service – a blood test, a pain pill, a bag of intravenous salt water – is standard for a certain procedure.
“It’s like trying to buy a car, piece by piece, from the ignition system to the exhaust pipes to the tires,” said Eric Borgerding, president of the Wisconsin Hospital Association. “You would need to know the cost of each piece to know the sticker price.”
A far more user-friendly system exists in Wisconsin through the Hospital Association, which has hosted its “PricePoint” website for years and refined it over time while expanding to 10 other states.
Searchable at www.wipricepoint.org, the site is updated quarterly with data from all Wisconsin hospitals. That data comes largely from discharge claims, which are required by law for all hospitals and ambulatory centers. Medicare and Medicaid patient data are included.
The system allows users to compare prices for similar operations statewide or within a certain geographic area, which is often how patients consider how to access care if their insurance coverage allows – or simply to compare what different health systems might charge for the same procedure.
“People should know how much their healthcare costs,” said Jennifer Mueller, WHA’s vice president and privacy officer. “We’re really trying to do what is easy and best for patients, who are more cost-conscious now.”
The PricePoint site is linked to a second online source, “CheckPoint,” which WHA established to display healthcare quality ratings for Wisconsin hospitals. It is updated periodically using eight data sources, including the federal Agency for Healthcare Research and Quality. CheckPoint is relatively new but used by three other states.
Here is how PricePoint works: Users first select whether their visit will be inpatient or outpatient. They are asked if they have health insurance and prompted to select a primary carrier. They are asked if their policy has an out-of-pocket limit (“I don’t know” is a possible answer) and then select a “body system,” meaning, essentially, tell us what needs care.
From there, a series of site “drop-downs” progressively become more specific about the type of procedure, the general geographic region desired by the patient and even the hospitals. At the end of the search, median charges and average length of stay is detailed. Up to three hospitals can be compared.
In January, 1,161 people used PricePoint with 18,606 page-views, according to WHA data.
The service can only take patients so far, of course, because they eventually need to pair what they learn on median prices for a medical procedure with what insurers will cover.
“At the end of the day, patients really need to call their insurance company and figure out what their deductible might be,” Mueller said.
The federal ChargeMaster system is viewed by some advocates as holding hospitals and health systems accountable for list prices that likely won’t resemble what is charged once insurance negotiations and deductibles are calculated. While ChargeMaster may help insurers and others with the time to parse mounds of complex data, it won’t likely help the average 60-year-old patient shopping for a knee replacement.
At least, not until smart, young coders at health information software firms figure out how to reduce it all to usable apps.
For the time being, however, Wisconsin-born PricePoint appears to have a dramatic head start on a national dilemma: How to help health consumers compare prices.
Still is president of the Wisconsin Technology Council. He is also a founder of the Wisconsin Healthcare Business Forum.