Maine hospitals reject report finding them noncompliant with price transparency rules
Federal law requires disclosure of standard charges and shoppable services
Federal law requires disclosure of standard charges and shoppable services
Federal law requires disclosure of standard charges and shoppable services
A new report finds Maine hospitals need to be more transparent about their prices and better comply with rules intended to empower patients and save them money.
But the Maine Hospital Association and its two largest members disputed the report.
The report from the nonpartisan, nonprofit Patient Rights Advocate concluded only 16% of the nation's hospitals are fully compliant with federal rules for disclosing all hospital prices for all services.
PRA reviewed about 2,000 of the 6,000 hospitals in the U.S. for compliance with a law in the Affordable Care Act signed by President Barack Obama and enforced by an executive order issued by President Donald Trump, which set a deadline of January 1, 2021 for compliance.
Cynthia Fisher, founder amd chair of Patient Rights Advocate, said, "Patients have been blind to prices, and then they get blind-sided by these outrageous medical bills."
Only 2 of the 11 Maine hospitals examined rated fully compliant – MaineGeneral Medical Center, in Augusta, and St. Joseph's Healthcare, in Bangor, a change from PRA’s prior report issued a year ago.
The other nine Maine hospitals categorized as not fully compliant include three in the MaineHealth chain – its flagship Maine Medical Center, in Portland, Southern Maine Health, in Biddeford, and Mid Coast Health, in Brunswick – and two in the Northern Light Health chain – its flagship Eastern Maine Medical Center and Northern Light Acadia, both in Bangor.
In addition, Central Maine Medical Center, in Lewiston, and three rural hospitals – Calais Regional Hospital, Houlton Regional Hospital, Waldo County General Hospital – were rated not fully compliant.
The general shortcoming, according to the report and research data PRA shared with WMTW, is that their hospital charges posted online do not list every cost for every service along with every contractually adjusted price for every plan from every insurer – such as Anthem, Aetna, Cigna, Humana, United Health Care -- and the discounted cash price.
Fisher said, "It prevents us from being able to shop and for the best quality of care at the best prices. Anyone would want to know where they can get an MRI for $300 versus paying $3,000."
But the Maine Hospital Association described the report as misleading and said its three dozen members have not seen proof of what's missing amog the thousands -- or even tens of thousands -- of lines of informaton published by each hospital.
“They’re committed to being compliant. We haven’t seen evidence that they aren’t,” said Jeff Austin, MHA Vice President of Government Affairs and Communications. “We’re not sure we can trust the conclusions of this particular report.”
Austin said at least one hospital had listed one price for a certain insurer because that was the negotiated rate for all of its plans.
John Porter, MaineHealth Vice President of System Communications and Public Affairs, said, “The Centers for Medicare and Medicaid Services is responsible for enforcing federal hospital price transparency regulations and is the sole body that determines whether a hospital organization is in compliance with these regulations. No MaineHealth hospital is currently out of compliance, per CMS.”
MaineHealth has a separate hospital price index for each of its 10 hospitals, as does Northern Light Health for its system.
Suzanne Spruce, Northern Light Health Senior Vice President, Marketing and Communications, said: “Earlier this year we learned we had a navigation and viewing issue with our online, price transparency information. The headers used were unclear and made it appear that we did not have each plan for each insurance provider listed. Those headers have been updated for clarity. We are fully compliant with price transparency requirements at all member organizations within our health care system.”
Fisher said 90% of hospital visits are planned, which makes the availability of true hospital prices, including adjustments for insurance, all the more valuable.
Fisher said, “Patients have been blind to prices and then they get blind-sided by these outrageous medical bills, and before we even get our care, we sign into the hospital and it goes into the digital record that we have to pay with a blank check whatever they choose to charge us, even beyond out health insurance coverage.”