Hospitals around the state, including St. John’s Medical Center, rang in the new year by posting their prices online.
The move was required by the Centers for Medicare and Medicaid Services beginning Jan. 1 as part of the 2,593-page Inpatient Prospective Payment System rule. Known as IPPS, the document increases price transparency for patients and boosts payments to acute-care hospitals.
Previously, hospitals had to make price information publicly available or available upon request. Now, they must publish the list of standard charges in a machine-readable format and update it annually when price increases are announced or when new services are added. The Wyoming Hospital Association, a nonprofit, supports the change.
“The Wyoming Hospital Association (WHA) and its member hospitals view this move as a step toward improved price transparency and working with consumers, so they know what their financial responsibility will be before, during and after their healthcare visit,” a press release stated.
Consumers can visit TinyURL.com/yajohl7v to see a standard list of charges from St. John’s — there are more than 13,000 procedures and services listed — plus a list of average prices for a variety of inpatient stays.
A patient’s financial responsibility likely varies significantly from the posted charges depending on insurance coverage, whether a service is covered, whether the provider is in the plan’s network, the plan’s cost-sharing requirements and if the patient has met the deductible. Uninsured patients will also see differences based on the hospital or provider’s self-pay discounts and sliding fee scales.
“It’s confusing,” hospital CFO John Kren said. “It’s list pricing only. It doesn’t reflect any promotions, discounts or insurance contractual arrangements. It’s not inclusive, so the best thing you can do is just call.”
He compared it to buying a car — the sticker price isn’t necessarily what you’re going to pay. Complexity of treatment often changes health care prices. For example, you might think you need two screws in your shoulder, but then you end up needing five and a plate, or you’re not sure if you have meniscus damage on top of an ACL tear until your orthopedic surgeon opens your knee and looks around.
“The story is never complete until you get in there and see what happened,” Kren said. “That’s the exact problem with health care pricing.”
St. John’s recommends patients contact the preservices department at 739-6161 or email@example.com to review costs for upcoming hospital treatments, review insurance benefits and get a better picture of expected costs. Kren said the hospital is “very supportive” of price transparency.
“Patients are going to know anyway,” he said. “There’s no reason to hide it.”