CLEVELAND — When you go to the hospital for a procedure, do you know how much it will cost? There’s been federal rules on the books for two years now that’s supposed to force hospitals to be transparent with their pricing. But are they working?
It depends on who you ask about whether or not hospitals are complying with the mandates. So, let’s lay it all out for you so you can decide for yourself.
“I get my vaccines from Cleveland Clinic for several things. I don’t think I’ve ever gone to an outside location for a vaccine,” said Brandee Spencer from Cleveland. She is on Medicare and got two doses of the shingles vaccine last fall at Cleveland Clinic.
“It’s a big deal when costs catch you off guard,” Spencer told us.
CLEVELAND CLINIC CHARGES $1,000 FOR VACCINE
She was surprised because she said her mother, who’s also on Medicare, got the shingles shots at a local pharmacy for about $100 total. However, because Spencer got the shots at the Clinic, when she eventually got her bill, it was about $1,000.
“I’m literally paying 10 times more for the same exact shot from the exact same manufacturer,” Spencer said in a frustrated tone.
She told us she wasn’t sure how large the bill would be. She said price transparency is critical for avoiding big charges.
“That’s how people end up in the poor house,” said Spencer. “That’s how people end up missing rent. That’s how people have to give up medications and end up in the hospital,” she added.
“You gotta know the numbers! You need to know the prices in advance of care,” said Cynthia Fisher of PatientRightsAdvocate.org. She told us she has been examining medical prices at hospitals since transparency rules went into effect in January of 2021.
“There’s no reason why we can’t competitively see prices on what one carrier charges or what one hospital charges,” Fisher said.
GROUP SAYS FEW HOSPITALS FOLLOWING MANDATES
The rules sayhospitals are now “required to provide clear accessible pricing information online” in two ways: a comprehensive machine-readable file with all items and services and a display of shoppable services in a consumer-friendly format.
“It’s not hard to post your price. Goodness knows these hospitals get paid every day and they bill knowing what the dollars and cents charges are,” Fisher said.
However, according to Fisher’s group that looked at 2,000 of the 6,000 hospitals nationwide, it found only 24.5% were following the rules.
“As long as hospitals and insurance companies keep prices hidden and prices in the dark, they can charge whatever they want,” Fisher told us.
In Ohio, it was worse. PatientRightsAdvocate.org said only 18% were compliant. It said numerous hospitals were not compliant in the Cleveland Clinic and University Hospitals systems. We asked the Clinic and UH to be transparent and answer our questions on camera. Both declined, saying they are following the rules.
HERE'S WHERE IT GETS WEIRDER
So, who’s right? The hospitals or the watchdog group? We asked the feds, and that’s where it got weirder.
As of February of this year, the Centers for Medicare and Medicaid Services (a.k.a. CMS) had handed out nearly 500 warning notices to non-compliant hospitals but only issued two fines. It begs the question of just how seriously is CMS taking this?
Then when we asked if Northeast Ohio hospitals were compliant, CMS issued a statement saying, in part “releasing the compliance and status of hospitals prematurely could identify hospitals that have already taken corrective actions…”
So, the very program that’s supposed to ensure transparency can’t be transparent enough to tell us who’s compliant?
MEDICAL ADMIN EXPERT WEIGHS IN
“There’s a lot of discussion around this and a lot of 'what does this mean?'” said Cody Mullen,a health administrative expert from Purdue University. We asked him to look at the websites for Cleveland Clinic and UH Hospitals.
“The machine-readable info was buried, and frankly, I had to email (News 5) to say, ‘Do you know where these are?’” Mullen said.
He did say for the consumer-friendly rules, there’s good information from the hospitals, but consumers could benefit from additional details when certain levels of care are listed without explanations.
“I couldn’t tell you as a professor in this field the exact difference between a level 4 and a level 5 (treatment),” Mullen said.
Meanwhile, Fisher’s group gave us specific examples of why some Northeast Ohio hospitals were not compliant as of its study, like insurance plan names not being correct and high percentages of the letters "N/A" being listed with no specific costs.
“When hospitals and insurance companies show all of their prices, they will have to compete on quality and price,” Fisher said.
CLEVELAND CLINIC SAYS $1,000 VACCINE JUSTIFIED
On behalf of Spencer, we asked Cleveland Clinic why her shingles shots cost 10 times more than a local pharmacy. Company representatives explained the shots were given in a different setting and there are different costs per access of points of care.
‘If someone had said the words $1,000, I don’t care what vaccine it was, I would have stopped and said, ‘Okay, let me call my insurance and go from there,'" Spencer said.
CMS recently said it sampled 600 hospitals and 70% are compliant, but that is a much smaller sample than the 2,000 hospitals the watchdog group looked into.
CMS did say it wants more standardized reporting of prices, better access to finding machine-readable files, and that it plans to take aggressive steps and action against hospitals not complying.
