Not all area hospitals complied with a Jan. 1 deadline to publish the price of standard services online.
Three area hospitals owned by Astria Health have failed to meet the deadline, but plan to be in compliance with the new federal rule by the end of the month, said spokeswoman Dawn O’Polka.
“They’re working on it right now, I can tell you that,” she said Friday.
Astria Health owns Astria Regional Medical Center in Yakima and two other facilities in the Lower Valley — Astria Toppenish Hospital and Astria Sunnyside Hospital.
The new rule by the Centers for Medicare & Medicaid Services intends to prevent patients from being surprised by unexpected medical costs due to insufficient price transparency. Out-of-network bills from doctors who provide services at in-network hospitals — such as anesthesiologists and radiologists — are examples.
Under the new federal rule, hospitals are required to define basic services and post standard charges online.
O’Polka said Astria’s hospital group is implementing a new electronic health record system for patients and that work has slowed online publishing of standard charges.
“All of the electronic health records connect to the pricing,” she said.
Implementing the new rule has been seamless for Virginia Mason Memorial hospital, which for years has listed the prices of standard services online.
“By default, most facilities are listing their basic charges,” said Virginia Mason Memorial CFO Tim Reed. “This is something I think we’ve been doing the past decade.”
Many hospitals across the state also report their standard charges to the state Department of Health, and that information is typically listed on the Washington State Hospital Association’s website.
The cost of some basic services at Astria’s hospitals are listed on that statewide website.
“We made a decision long ago to use available information on pricing for us to be as transparent as we can,” said Claudia Sanders, vice president of special projects at the state hospital association.
No Penalty?
There doesn’t appear to be any penalty for hospitals that fail to comply with the new rule.
“What wasn’t articulated in the rule is whether there are any penalties for not meeting the deadline,” Reed said. “Typically, they’ll try to incentivize first, then ramp up penalties later.”
O’Polka said Astria hasn’t had any fallout from not meeting the Tuesday deadline.
“It’s a ruling, not a law or anything,” she said. “It’s a ruling that we’re working to comply with.”
That possibly could change if hospitals continue to ignore the new rule, said Andrew Busz, policy director of finance for the state hospital association.
“It is a requirement, it’s out there and I think (Centers for Medicare & Medicaid Services) will be evaluating to see if they need to do anything further,” he said. “At this time we’ve been encouraging hospitals to comply and our understanding is hospitals are working hard to comply.”
O’Polka said patients can simply call the hospital to get pricing information and how much they will pay out-of-pocket after their insurance coverage is factored.
“We’ve always provided that,” she said.
Cost Analysis
Simply comparing standard costs can be misleading.
What hospitals define as basic care can differ, and that can make costs look lopsided, O’Polka said.
For example, the average cost of a basic joint replacement at Virginia Mason Memorial is $32,717 with an average hospital stay of 1.6 days, according to the state hospital association’s website.
The cost at Astria Sunnyside Hospital is $132,544, but that includes a 4.3-day hospital stay and rehab services. Other hospitals refer rehab services to an outside facility with a separate cost that doesn’t show up in the hospital’s price, O’Polka said.
Reed said most people want to know what their cost will be after their insurer pays its portion, a calculation that isn’t factored when simply comparing prices.
“That’s what people typically want to know: What is it going to cost me versus what you charge?” he said.
He assumes the new rule will be fine-tuned in the future to offer insurance calculators that provide out-of-pocket cost.
While some have criticized the new rule, he says it is much needed and will be improved moving forward.
“It’s a step in the right direction for transparency,” he said.
