A recently released report by a nonprofit organization says it’s a mixed bag when it comes to North Carolina hospitals complying with a federal price transparency law put in place two years ago.
The 4th Semi-Annual Hospital Price Transparency Compliance Report was put together from a study by PatientRightsAdvocate.org. It shows that 28 out of the 51 hospitals, or 55%, in the state that the organization evaluated met its criteria. North Carolina has a total of 110 hospitals. The study shows that less than 25% of hospitals across the country were fully compliant, making North Carolina’s rate considerably higher.
The organization, according to founder and chairman Cynthia Fisher, is focused on lowering the cost of healthcare and empowering consumers to be well informed about all prices systemwide in healthcare so that they can have choices and prevent them from being overcharged.
“People need financial certainty and need actual prices,” Fisher told Carolina Journal in a telephone interview Monday. “Estimates don’t really work because they’re not accountable but actual prices are accountable. In order for all these hospitals to bill their patients every day, they know these prices in advance and they also know how to convert the formulas into dollars and cents, and they clearly know every plan name and every procedure name and code.”
The organization reviewed 2,000 of the largest hospital systems in the U.S.
“We took two months to look at their data and look at what really matters in this law: to able to create competition so price transparency empowers consumers to benefit from competition,” Fisher told CJ. “It also shows every single negotiated price they have with every insurance company they accept in their hospitals. So, the beauty in this whole rule of law is really to lower the cost by having wide-scale competition which only benefits consumers to improve quality while lowering costs.”
She said patients should also be able to see the discounted cash price and have the option to be able to pay and settle their bill at that price.
UNC Medical Center and UNC Rex Healthcare, Atrium Health, and Novant Health were among those that were compliant.
Those that were not include Duke University Hospital, Duke Regional Hospital, and WakeMed Raleigh.
The report stated that the two Duke facilities failed to provide an adequate number of their lowest charges for a service and failed to adequately identify specific plans for all commercial payers, for example, distinguishing between Cigna and Cigna Connect. The report found that to be the most common criticism among non-compliant hospitals in the state.
Duke Health did not respond to a request for comment prior to the publication of this article.
WakeMed’s list of standard charges failed to provide an adequate amount of gross charges and negotiated rates, according to the report.
“CMS is the official agency to determine compliance with the federal regulations,” said WakeMed spokeswoman Kristin Kelly in an email to CJ referring to the Centers for Medicare and Medicaid Services. “Both CMS and the North Carolina Attorney General’s office found WakeMed to be in compliance with price transparency requirements on the state and federal level. We are not certain how this advocacy group makes their determination, so it’s important to rely on CMS for reporting on this topic.”
The rule for hospital price transparency came from the Affordable Care Act or Obamacare, but turning it into standard practice has taken time.
“So, the Obama Administration and Biden gave us the right to know all prices from the hospitals,” she said. “However, it sat on the shelf more or less until the Trump Administration came in and made it into rule of law and so Health and Human Services put it into actionable administrative rule of law making the hospitals as of January 1, 2021, post all prices online. The year before that, they were given a year to come on board when they sued the Department of Justice and they lost in the lower courts, and they lost in the upper courts trying to use the First Amendment to say they could have the right to keep prices secret and hidden from consumers.”
Fisher said there can be significant price variations on different procedures from one plan to another. For example, the cost of childbirth could vary from one hospital charging a woman $6,000 to get a C-section, and another will charge over $60,000 for the same uncomplicated procedure with the same types of medical staff and coding.
In order to make pricing information widely available to patients, Fisher said hospitals must create data files that can be converted into a readable form so they can be downloaded. They must also be machine-readable so that data can be parsed. Right now, search engines like Google and Yahoo cannot show comparative prices on tests like an MRI based upon pricing within that individual hospital if a report is missing wide swaths of data that allow for comparative pricing, making a hospital non-compliant.
Two hospitals in Georgia were fined last year by the Centers for Medicare and Medicaid Services (CMS) for not having files. They became compliant within two weeks.
“This is an industry that has built that spent 40 years building up a shroud of secrecy that continues to give the middle finger to both presidents of the United States and we’re now in a situation because of their lack of compliance,” North Carolina State Treasurer Dale Folwell told Carolina Journal Tuesday in a telephone interview. “What we’re talking about ultimately is a transfer of wealth from average people, many of whom are fixed-income individuals, to these multibillion-dollar corporations who disguise themselves as nonprofits.”
Folwell has long been a champion for transparency in North Carolina hospital systems, issuing many watchdog reports, including how some have misspent COVID-19 funds. He also fought for H.B. 1039, Medical De-Weaponization Act, which didn’t get past the House Banking Committee last year. Folwell said it is being filed again during this year’s long session in the General Assembly and has a good chance of passing.
“I think it has a good shot, especially considering that the people of Arizona had a medical debt de-weaponization referendum on the ballot last November,” he said. “They have a different system than we did, but it passed by 72%. I think it just comes down to whether people really listen to their constituents. They have to make a decision whether they want to be on the right side of history or not and that’s what gives me optimism.”