More than two years after a federal rule required all hospitals to post what they charge patients, compliance with the rule has been poor. Knowing that hospitals mostly failed to meet the requirements of the Hospital Price Transparency rule effective on Jan. 1, 2021, Mary Katherine Wildeman (@mkwildeman), a data reporter for the Associated Press, spent months last year determining how well Connecticut’s health systems were complying with the rule. At the time, Wildeman worked as a data reporter for Hearst Connecticut Media.
Wildeman’s reporting on hospital price transparency is significant for many reasons, including these four:
- First, the lessons she learned from poring over hospital websites and interviewing administrators and health policy experts are useful for all health care journalists.
- Second, her articles on hospital prices have such a strong consumer-empowerment angle that led, at least in part, to a new state law to cap rising health care costs.
- Third, her reporting was published last year before researchers and other journalists began digging into this important issue.
- Fourth, when hospitals publish what they charge, consumers should be able to compare prices across hospitals before getting care, but Wildeman showed that’s not always true.
Two federal rules
The Hospital Price Transparency rule is part of a two-pronged effort from the federal Centers for Medicare and Medicaid Services (CMS) to make health care price information available to consumers. In the first part of the program, hospitals were required to post their prices beginning Jan. 1, 2021. The second part affects health insurers under the Transparency in Coverage final rule that requires most group health plans to post information on what consumers pay for covered services. CMS began enforcing the second part on July 1, 2022. The rule exempts grandfathered health plans that were operating on March 23, 2010, the day the Affordable Care Act was signed into law.
At the start of 2023, health plans were required to provide information on the costs of 500 common shoppable (meaning non-urgent) items and services. By Jan. 1, 2024, health plans must post prices for every covered item and service.
Now is the time for journalists to become familiar with how hospitals are complying. Under its hospital price transparency rules, CMS requires the nation’s 6,093 hospitals to provide clear, accessible pricing information online about their services as a machine-readable file showing all items and services and as a list of shoppable services in a consumer-friendly format.
In a recent Health Affairs article, however, CMS officials said not all hospitals have complied, meaning consumers could still be confused because only some pricing data would be useful. Wildeman also explained that the negotiated rates hospitals post are unlikely to be what patients would see on their bills.
“Instead, how much a patient must pay depends on specific circumstances unique to them,” Wildeman said. Any patient who still must meet his or her deductible would have to pay the full amount.
For her first article in the series, Wildeman’s lede focused on what a woman with health insurance from Anthem (now called Elevance) might pay for a Caesarean section at St. Vincent’s Medical Center in Bridgeport ($10,988) versus what that same patient would pay at the nearby Bridgeport Hospital (less than half of what St. Vincent’s posted).
Every health insurer negotiates different prices for procedures at each hospital, she added.
“But understanding these prices is critical because patients are typically on the hook for at least a portion — and in some cases all — of what an insurer agrees to pay a hospital,” she wrote. “How much of a negotiated rate a patient will have to pay depends on the details of their plan.”
Tracking hospital prices
The challenge for journalists is gathering price information scattered across individual hospital websites and in different formats, she noted. Tracking how prices vary from one institution to the next is not easy, which renders the pricing data largely useless to the average patient, she explained.
In other words, tackling this assignment requires the skills of a data reporter. Last May, Wildeman earned a master’s degree in data science and analytics from the University of Missouri.
When the hospital price rule went into effect in 2021, Wildeman checked a few websites for Connecticut hospitals and found that most had posted some price information. “But compliance was spotty in terms of actually disclosing negotiated rates with insurers,” she said. “Over time, compliance seemed to improve to the point where they have all posted some negotiated rates, as far as I can tell.”
For the project, Wildeman sought to collect prices from all 31 acute care hospitals affiliated with the state’s eight health systems. Still, gaps are possible because some network hospitals post their prices together, meaning the price at one hospital could be the same at another hospital in the same system.
One of her biggest challenges was translating the data from the different formats that the hospitals used into numbers useful for consumers. To do so, she developed a formula using hospital procedure codes to allow consumers to compare prices.
“I found it best to use CPT and HCPCS codes,” she said, referring to the Common Procedural Terminology codes and the Healthcare Common Procedure Coding System. Then she matched each code to its descriptions from the American Medical Association.
One problem Wildeman found was that often one hospital would list more than one price for the same service but offer no explanation. “In those cases, I reported a median charge,” she said.
Another challenge came from trying to understand why some hospitals would list a price based on a billing code and another price based on a more specific procedure code. “I saw this happen if one procedure was done in different areas of the same hospital,” she said.
When she encountered such problems, she sought guidance from experts, such as Keith Ericson, a researcher and associate professor of markets, public policy, and law at Boston University’s Questrom School of Business. She found Ericson and other experts on SciLine, a nonpartisan, nonprofit service of the American Academy for the Advancement of Science that connects journalists to scientists.
Hearst Connecticut Media has posted Wildeman’s hospital transparency work on a project page that includes a link to the data she published on GitHub. Also contributing to the project were Derek Turner, a web producer, and Matt Rocheleau, an editor.
- “Hospital Price Transparency: Progress And Commitment To Achieving Its Potential,” Health Affairs, Feb. 14, 2023.
- “Want a Clue on Health Care Costs in Advance? New Tools Take a Crack at It,” Julie Appleby for Kaiser Health News, Jan. 3, 2023.
- “Hospital And Insurer Price Transparency Rules Now In Effect But Compliance Is Still Far Away,” Health Affairs, Sept. 12, 2022.
- “Hospital care costs are wildly different across CT. Explore the once secret data,” Mary Katherine Wildeman, CT Post, April 28, 2022.
- “5 things to know about CT hospital prices from our review of once-secret data,” Wildeman, CT Post, May 2, 2022.
- “New CT law aims to cap rising health care prices,” Wildeman, CT Post, May 8, 2022.