What is the cost of that surgery? Well, figuring out that information is supposed to be getting easier. New hospital pricing transparency rules were set to go into effect on January 1, 2021. The rules met resistance from hospital associations throughout the rule-making process, and are meeting noncompliance now that they are in effect. Transparency in hospital billing is something we contend with in many of our cases.
Centers for Medicare and Medicaid Services (CMS) established a rule that requires hospitals to provide clear, accessible pricing information online about items and services they provide. The idea is to make it easier for folks like you and I to shop and compare prices between hospitals and to be able to estimate the costs of procedures before committing to them. The rules require hospitals to “display online in a consumer-friendly format”… the negotiated charged prices, discounted cash prices, and the high-low range of negotiated charges for at least 70 specific CMS services and a total of 300 elective procedures.
A national review of hospital pricing has revealed major variations not just across regions, but sometimes even within the same hospital. Comparatively, hospitals in the Seattle area are posting some charges for some procedures, but compliance is not yet 100%. This appears to be the case across the country.
In many of our cases a substantial factor in damages is the high cost of necessary future procedures. And we are tasked with including the cost of that procedure in the future damages calculation: eg, “but for the defendant’s negligence, Ms. Client would not have needed a kidney transplant.” We rely on experts to calculate these costs. Sometimes the costs come from prior care the patient has already received. Sometimes our expert has to find costs by calling hospitals in the client’s area to get estimates, the compiling those into damages reports. They know the language to use with the hospitals and the right procedure codes to get the right information. But relying on someone like this is impractical for an average person, who also has to navigate their insurer to find what their final cost will be.
These new rules may be a step in the right direction, but they still reveal how far we may yet need to go.
