New Orleans The weather forecast included both thundershowers and a tornado warning, but when asked if we should go ahead with the often scheduled and postponed press conference to release our study on hospital pricing transparency, the decision was easy: go! So, there we were in front of Ochsner-Baptist Hospital, a major unit in the giant nonprofit healthcare chain in southern Louisiana. Rain and wind turned out not to be an issue, but caterpillars falling on people from the oak trees led to constant surveillance. No worries, I thought. We’re in front of the emergency room. What could go wrong?
ACORN International, Labor Neighbor Research & Training Center, and Local 100, United Labor Unions had combined forces over the last more than year with a small army of student volunteers from Tulane and the University of Ottawa to look at the level of compliance and practice by hospitals in implementing a price comparison and transparency rule promulgated by the Center for Medicare and Medicaid Systems (CMS). After years of litigation by the American Hospital Association had ended in one court defeat after another, finally in 2020 the AHA had thrown in the towel, allowing the regulation to go into effect on January 1, 2021. All hospitals in the USA were required to post their price schedule for more than 200 procedures on their website in a “machine readable” way to allow patient-consumers to compare prices when having a medical procedure. The overarching policy aim by the government was to use transparency to indirectly pressure hospitals to reduce prices by empowering patient-consumers.
We didn’t have the resources to look at all the hospitals in the country, so we focused on the more than 600 hospitals in the Arkansas-Louisiana-Texas industry that aligned with many of our offices and the union’s membership and jurisdiction. Our report found that the effort had failed miserably. In each state more than half of the hospitals continue to be scofflaws and haven’t even posted yet. We’ve filed more than 100 complaints on non-filers with CMS. Others tried to block easy access or steer people into their proprietary “price tool”, as Ochsner had done. We ended up comparing a finite set of common procedures to get a snapshot of the problem, like the cost of a cesarian section for a pregnancy. The range was astonishing from hospital to hospital, but also in some cases hospitals would list scores of prices for such a procedure based on their own coding system and insurance chargemaster, sowing even more confusion.
Regardless, we found some interesting things. Normally, public and nonprofit hospitals are less expensive in Arkansas and Texas than for profits, but in Louisiana nonprofits edge out public and for-profits, perhaps because of Ochsner’s dominance of the several markets. The most expense markets were in the Fayetteville-Springdale-Rogers area of Arkansas, the Lake Charles, Louisiana metro areas, and Longview, Texas. In general, pricing was higher in Texas, followed by Louisiana, and then Arkansas. All the backup data and the reports are on our websites, and there’s gold in those hills, but the real question is what to do about all of this?
We argued to the press, as the media coverage demonstrates, that CMS needs to slap real penalties on noncompliance. They need to mandate one coding system and a clear, standardized, transparent reporting template, so that not only are these prices actually machine-readable, but easily accessible to patient-consumers. CMS needs to require insurance companies to disclose reimbursement data. I could go on, but they must be tearing their hair in Washington at CMS, just as we have been doing in New Orleans and Little Rock, because so much of what hospitals are providing is useless. Hospitals seem to have adopted a strategy of having failed in court to now either refusing to comply with impunity or completely obfuscating the data they provide to thwart the rule and any transparency.
This is a farce that is crippling access to healthcare. Governments at all levels need to hunker down, buck up, and slap back with decisive action. We’re going to continue to push for change.