Bothwell Regional Health Center recently added a price transparency estimator to its website in compliance with new rules from the federal Departments of Health and Human Services (HHS), Treasury and Labor that require hospitals and health systems to expand data available to patients and the public.
Existing HHS guidance from the Centers for Medicare & Medicaid Services (CMS) requires all U.S. hospitals to make their list of current standard charges public online, whether in the form of a “chargemaster” or another form of the hospital’s choice. Bothwell has provided the chargemaster list of current standard charges on its website for several years.
The new rules, which went into effect Jan. 1, require disclosure of all standard charges including privately negotiated rates with insurers, gross charges — which would include chargemaster prices — and discounted cash prices. In addition, hospitals must offer an out-of-pocket price estimator tool or negotiated rate information on 300 shoppable services for patients in connection with an inpatient admission or an outpatient department visit for which a hospital has established a standard charge.
According to Steve Davis, Bothwell’s chief financial officer, the new price estimator includes the ability to search by an individual’s insurance carrier and will estimate out-of-pocket expenses for hundreds of services, treatments and tests even if a person’s deductible has been met.
“The theory behind the new rule is great,” Davis said. “It allows the public to do research and make better-informed decisions about the cost of services and have fewer surprises with billing.”
Davis cautioned that the tool only estimates costs and isn’t a guarantee of final billed charges. Estimates are based on average charges and may vary based on patient health condition, unknown circumstances or complications, final diagnosis and recommended treatment ordered by a physician.
“There are set prices for tests and services, such as MRIs, CTs or sleep studies,” he said. “However, costs for other services, such as surgeries, inpatient stays and emergency room visits can vary. Every person is different, and physicians differ in their treatments, medications ordered and recommended lengths of stay all of which can impact final billing.”
Under the CMS final rule, about 200 million Americans will gain access to real-time price information, enabling them to know how much their health care will cost them before going in for treatment.
“We know that most people don’t plan for medical expenses even if they have insurance,” Davis said. “This new tool is just another way to provide as much financial information as possible for our patients,” Davis said.
Bothwell’s price transparency estimator tool and chargemaster list of standard charges can be found on the Price Transparency Page.