Health Care Price Transparency

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Would you drop your car off at an auto shop for repair with no idea of how much it would cost to get it fixed? Probably not, yet this is what America’s health care system offers its sick citizens.

As any patient who has received an Explanation of Benefits understands … deciphering health care is complicated. To help, The Centers for Medicaid and Medicare Services (CMS), on January 1, 2019, required hospitals to post charges. CMS is the federal agency charged with wrangling the health care of 35 percent of Americans via Medicare and Medicaid (Jefferson Healthcare’s Medicare/Medicaid total business percentage is 75 percent - PT Leader 2019). This winter, hospitals all across America complied with the new rule, posting charges for: services, procedures, tests, medicines and supplies.

But some hospitals’ charge lists are more helpful than others. In Millersburg, OH, Pomerene Hospital (55 beds) published an online charge list of eleven common categories of care, including Room and Board, Labor and Delivery, X-Ray and Radiological, Laboratory, along with seven other areas of service. Under the headings are more detailed lists of services, with plain descriptive language along with charges. Some hospitals provide pricing tools which give patients charge information to comparison shop, should they care, or need to.

Jefferson Healthcare’s online charge tool is 290-plus pages of cryptic and arcane description.

The first service listed is PRO FEE PNEUMOCOCCAL VACCINE 13 VALENT. The second is EXC PACE LES SC

Public Hospital District #2 Commissioner Kolff, in a recent Leader article, begins a conversation with our citizens about subsidized services and the sacrifices a community might make to have broad essential health care. This is a long-needed discussion! Which kind of service is essential? Which kind of service makes a profit? Which kind of service needs to be subsidized? Who makes sacrifices?

What kind of service deserves promotion, and what kind does not? Joint replacement surgery has gotten plenty of advertising from Jefferson Healthcare over the years. Why have Type 2 Diabetes, Smoking Cessation, Obesity and Substance Use Disorder Treatment (all conditions included in America’s lists of top-10 health maladies) received little or none? Recently, a community member’s overdose death was reported in the papers. I wonder how many people know that Jefferson Healthcare provides opioid treatment care.

This morning, I took advice from Jefferson Healthcare’s website to compare hospital pricing via the Washington State Hospital Association online charge comparison tool. I compared charges for “Major Joint Replacement or reattachment of lower extremity w/o MCC” (without major complication or comorbidity). According to the WSHA website, Olympic Medical Center’s median charge for Major Joint Replacement is $30,976. Mason General’s median charge is $51,222. Jefferson Healthcare’s median charge is $69,184.

About a year ago, Governor Inslee’s office announced a new Health Care Compare website to help make health care costs more transparent. In the governor’s words, “Health care can be an enormous expense for many families, and giving people a way to compare the prices and quality will help people be better informed and prepared about their options. It’s also enormously helpful for lawmakers, employers and providers to have increased transparency about the costs related to using and buying health care.”

In 2017 a brain MRI was needed by a family member. Olympic Medical Center’s chargemaster phone quote was $2,400—out of pocket cost was $360. Jefferson Healthcare’s chargemaster phone quote was $2,867 with an out of pocket cost of $430. The procedure was completed at InHealth Imaging in Poulsbo, with immediate review by a radiologist, for $885, out of pocket cost $132.

Some county citizens have Affordable Care Act family deductibles of $15,800 this year. Care charges are important to families when deciding if they can afford to treat their child’s ailment—or not.

It might appear Jefferson Healthcare is being picked on, but our only county hospital illustrates America’s health care transparency problem. I agree with Commissioner Kolff. Having robust, all-hours, community health care service is important to Jefferson County. A community discussion about the tradeoffs and sacrifices required to provide essential health care service is a vital debate to have. Any discussion needs a starting point. Maybe better health care price transparency could be the information that gets the debate rolling. Again, Commissioner Kolff is right when he said, “It is a challenging time for rural hospitals to stay afloat.” Agreed. Let’s get our community on the oars and begin to row America’s health care toward better, more open water.

Stephen Workman is an advocate for better behavioral health patient outcomes in America. He has attended or listened to nearly every Jefferson County Public Hospital District No. 2 meeting since 2011. He also attends the local Health Care Access forum in Port Townsend monthly.