08 Jul Hospital Pricing
In our January Newsletter, we discussed the government’s attempt to bring transparency to hospital pricing. According to the new rule, hospitals must provide hospital pricing to consumers by January 1, 2021. Several area health systems already posted costs for procedures in an attempt to comply with the hospital price transparency. For instance, BJC, Mercy and SSM created online portals to compare pricing for procedures. Unfortunately, the data can be difficult to understand and you need to know the exact procedure name or ICD code to obtain an accurate estimate. Even then, there are extensive disclaimers to the hospital pricing listed claiming they are subject to adjustments, discounts, ancillary procedures or supplies and medication.
I compared a single diagnostic procedure between healthcare systems and hospitals. Sometimes there were substantial hospital pricing differentials between hospitals within the same system as seen in the chart below.
|DIAGNOSTIC IMAGING – MRI SCAN OF BRAIN, WITH AND WITHOUT CONTRAST (ICD Code: 70553)|
|Mercy St. Louis||$4,696|
|St. Joseph – St. Charles||$3,500|
|St. Louis University||$4,000|
I also compared a common pain management procedure with less success. BJC did not list any similar procedure in their pricing so I could only compare Mercy and SSM. Mercy South was half the price of SLU Hospital. If treatment involves multiple injections, these price differences can add up quickly.
|OPERATING ROOM – INJECTION OF SUBSTANCE INTO SPINAL CANAL OF LOWER BACK OR SACRUM USING IMAGING GUIDANCE (ICD Code: 62323)|
|Alton Memorial||Not Available|
|Mercy St. Louis||$2,599|
|St. Joseph – St. Charles||$2,400|
|St. Louis University||$3,100|
This is a good start at increasing transparency in hospital billing and giving power to the consumers. In most situations, however, people will be at a hospital because of an emergency and the price will probably not be a consideration. If it is not an emergency, however, it may be worthwhile to research the cost and then see how health insurance factors into the price for which you may be responsible. It will be interesting to see how this information will be used in the future. Access to this data is a great first step to eliminating some of the surprise medical billing associated with obtaining healthcare.
Tarun B. Rana, Esq.
Rana Law Group
655 Craig Road, Suite 252
St. Louis, MO 63141