Traverse City News and Events

Is The Price For C1 Esterase Inhibitor Fair? Who Knows.

By Ross Boissoneau | Jan. 23, 2019

A new rule that took effect Jan. 1 mandates hospitals across the country post prices for their procedures and services. The intent was to enable prospective patients to see what similar services would cost at various institutions. But according to some – including those The Ticker spoke to locally at Munson Healthcare – the reality so far isn’t quite as clear as the intention.  
 
Unless people know what a “THERA DOSIMETRY CALCULATION” or “ST EVAL AUG COMM SGD 1ST HR” are, chances are that trying to use the current price guides (known as Chargemasters) is futile. These two listings are taken directly from Munson’s Chargemaster, and come in at $660.10 and $358, respectively.
 
Adding to the confusion is the fact that each hospital uses different verbiage for similar procedures or has a slight difference among services. It’s even impossible to compare prices at Munson with those at Manistee Hospital because all individual codings on Manistee’s Chargemaster begin with a number. And that’s without even getting into what the various insurance companies will pay, based on their different policies and a patient’s coverage.
 
“I think the intent was to enable consumers to compare prices for more choice. The intent was good. We think transparency is good. But refinement is necessary,” says Munson Healthcare Spokesperson Dianne Michalek.
 
There are also so many entries: 6,800-plus are listed on Munson’s site. But perhaps the biggest issue is how they’re written, in a code known to the hospital but not the average consumer. Some are pretty straightforward: “PREGNANCY TEST URINE POC” is $45.60. ABSORBABLE GELATIN SPONGE (GELFOAM) SIZE 12-7 runs $14.40. But ANA PATTERN TITER costs $87.80, and C1 ESTERASE INHIBITOR, HUMAN 500 INTLUNIT INJECT is $9,526.25.
 
Michalek says she advises anyone wanting to know their personal out-of-pocket cost beforehand check with one of Munson’s financial counselors. “Call the hospital. Let us work with you,” she says.
 
She adds that another concern is if price is the primary thing people look at, they may decide where to go before considering all options or choose to skip treatment altogether. “They may say, ‘I can’t afford that’ and delay treatment.”
 
In fact, on Munson’s Chargemaster page, the second paragraph explicitly states that consumers should be careful not to read too much into the posted charges. “Please understand that the charges in the document do not accurately determine what any patient will pay. Health care costs are complex issues.” 
 
Michalek says cost is only one part of the care equation. “Price should not be the only consideration. People should also look at quality and safety.” That’s borne out in a study published in Health Affairs, which demonstrated that the list prices for hospital procedures are not necessarily correlated with the quality of care provided.
 
The Health Affairs study also found that prices vary widely across hospitals and are more than three times what hospitals are paid for treating a patient, on average. 
 
Even trying to compare prices at a hospital with a national average is a Herculean task. The different codes and procedures, the lack of a clearinghouse of such information, and a lack of state reports make that nearly impossible (Michigan is among 23 states which do not have pricing information at Consumer Health Ratings).
 
The Centers for Medicare and Medicaid Services posted average online charges from more than 3,000 hospitals nationwide for the 100 most common inpatient procedures and 30 common outpatient procedures paid for by Medicare. But trying to plug the codes from Chargemasters into it most often results in no match and more frustration.
 
As for the differences among hospitals and pricing within the Munson Healthcare Network, Michalak says that is due to many factors, such as whether it’s a Level 2 Trauma Center, a critical access hospital or has some other particular status.
 
Ultimately, Michalek asks rhethorically, “is the rule beneficial to consumers? It will not be very useful for a patient. It needs refinement.”

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