DULUTH —Hospitals already are working to comply with a new Trump administration requirement that won’t take effect for more than a year, while hoping it never actually comes to pass.
"We’re already starting to decide how we’re going to do this, how we’ll display it and how we’ll make sure we’re complying with the new regulation," said Eric Lohn, vice president and chief financial officer of St. Luke’s Hospital in Duluth. "It’ll be a full-year project."
The requirement, announced on Nov. 15 and set to take effect on Jan. 1, 2021, will force hospitals to publicly list the prices they’ve negotiated with insurance companies. That will be added to the hospital's list charges, which they've been required to post since Jan. 1 of this year.
All of this might sound simple. In the strange world of hospital pricing, it’s not.
"Right now we have about 10,000 line items for charges, and that’s all we have to list right now," said David Pilot, vice president of finance at Essentia Health. "This would create … probably 250 to 300 columns for each charge we have.
"It’s going to create a monstrosity of a spreadsheet that I don’t think is going to be very useful for the patient."
Lohn said he’s not sure exactly how all of these different prices for the same service at the same hospital came about, but it seems to have started with Medicare, which simply dictates the prices it’s willing to pay. Commercial insurers don’t have as much power, but they do negotiate for rates below what the hospital lists. Those rates might vary from one insurer to another, though, as insurers representing more patients bargain for bigger discounts.
"So, you see, you really end up with a different negotiated rate pretty much for every group," Lohn said.
Hospitals aren’t wild about the idea of listing negotiated prices. The American Hospital Association and three other organizations are challenging it in court. "This rule will introduce widespread confusion, accelerate anti-competitive behavior among health insurers and stymie innovations in value-based care delivery," the hospital association claimed in a statement.
Industry officials believe the regulation actually could end up raising healthcare prices, Lohn said. For one thing, complying would represent an additional cost to hospitals, and that ultimately would be borne by patients. For another, it’s thought that when one hospital learns a competitive hospital is charging higher rates, it might raise its rates as well.
A major Minnesota insurer shares the concern.
"This rule is unlikely to actually reduce healthcare costs," wrote Scott Keefer, vice president of public affairs for Blue Cross Blue Shield of Minnesota, in a blog post. "Unfortunately, it will likely have the unintended consequence of driving prices even higher."
Keefer offered the same argument as Lohn: Hospitals receiving lower rates will want to catch up with those getting more.
Keefer, Lohn and Pilot all say they’re in favor of transparency when it comes to hospital prices. But they argue that the new requirement won’t achieve that.
Patients don’t care so much about what a procedure costs as about what they’ll have to pay, Lohn said. For that information, both Lohn and Pilot said, your insurer is your best source of information.
"They have the specifics of your plan (and) what your claims to date have been," Lohn said. "If I were a patient looking at what will my true out-of-pocket be if I go to St. Luke’s for this procedure, I would start there."
But when the hospitals are asked that question, both Essentia and St. Luke’s are adapting ways of providing patients with more accurate information than in the past.
At St. Luke’s, Lohn said, software has been in place for about six months allowing its customer service representatives to access the patient’s insurance information (with the patient’s permission), and provide a dollar figure on what the out-of-pocket cost should be for a specific procedure.
Essentia is putting in place a similar tool, Pilot said, but it will allow patients to access the information on their own from the Essentia website.
"It’s a complicated process because we’ve had to rebuild our insurance plan codes to be able to do this," he said. "But we hope somewhere in the April-to-June time frame we’ll have a very robust estimation tool that patients can access."
St. Luke’s is looking at the possibility of making its tool available online in the future, Lohn said.