Better Solutions for Healthcare

Healthcare Finance: Colorado signs law mandating that hospitals post self-pay prices

Colorado signs law mandating that hospitals post self-pay prices
Healthcare Finance
By Susan Morse
January 5, 2018

A new law in Colorado that went into effect Monday mandates hospitals to post the self-pay prices of common procedures.

The Colorado Senate bill had the motive of price transparency. Legislators want patients to get prices from their providers without having to go through their health insurer for an estimate, according to the Denver Business Journal.

As high-deductible insurance plans become the norm, price transparency has been touted as a way to get consumers more involved in the cost of their healthcare to compare, for example the variation in the cost of imaging services.

This past summer, Anthem said it would no longer pay hospitals in five states for outpatient imaging services for MRIs or CT scans, since these services could be as safely provided and cost less at freestanding facilities.

Bringing down the cost of healthcare requires patient involvement, but so far most consumers have shown a marked lack of interest in comparison shopping.

It’s not that people aren’t willing to go out of their way, or trade hospital prestige or distance to save money, according to a new KelloggInsight report. It’s just that pricing is not being presented in a simplified enough way for consumers to make informed decisions, according to Elena Prager, an assistant professor of strategy at Kellogg.

The Colorado “Transparency in Health Care Prices Act,” is meant to simplify pricing, but in searching for prices at two acute care hospitals in the state, it’s difficult to make an apple-to-apple comparison.

Denver Health is an urban acute care hospital. Its self-pay pricing is listed on its website under the heading “For Patients and Visitors” and the subheading for billing and insurance.

It encourages patients without health insurance and who plan to pay for care directly to contact Denver Health’s financial counseling department. It also comes with the caveat that the prices may not reflect the total amount a patient may owe after receiving healthcare services.

The pricing does not include professional physician fees, medications, medical devices, or rehab or home health services, the Denver Health site says.

The Delta County Memorial Hospital is also an acute care provider in a more rural setting about 240 miles from Denver. It also lists a number to call for payment options and a disclaimer that prices are an estimate for services without complications.

At Denver Health, childbirth delivery without complications is $4,736.44. At Delta Memorial, the same DRG 775 for a vaginal delivery without a complicating diagnoses is $9.068.18

Other procedures do not readily match up.

At Denver Health, disorders of personality and impulse control is among the costliest, at $32,154, as is infectious and parasitic diseases, including HIV with an operating room procedure, at $34,219.

Under outpatient surgery, Denver Health lists a price of $25,430 for evaluation and insertion of catheters for a complete heart block and $2,382 for the removal of a cataract with insertion of a lens.

It was hard to find comparisons for the same procedures at Delta Memorial.

Delta has both a physician and facility price sheet, something the Denver system does not have.

The facility price sheet lists discounts based on income, with individuals making $30,000 or less a year receiving a 25 percent discount. The discounts get lower with income, but even those making $71,000-plus get a 10 percent discount.

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