Mandatory Posting of Hospital Charges: Rest In Peace.

I thought that before I signed the death certificate of the Posting Standard Charges Project, that I would place a mirror beneath its nostrils just to make sure it was ready to put in the ground. I was planning to add this confirmatory step as an addendum or comment to my first article, but it was clear that additional details and discussion would be necessary. My first pronouncement was based on a bedside-look at the several chargemaster databases. What did the local hospitals choose to disclose; what must they have intentionally omitted; how easy was it to find anything; and was the information useful to compare different hospitals? I did not even have to feel for a pulse to know the answers. Out of fairness and a desire not to bury the patient alive (but with certainty that my initial diagnosis was correct) I applied a more definitive diagnostic test that might been a valid real-world trial for me had these posted standard charges been available last Fall.

As I pulled away from my cardiac pit stop at Rhode Island Hospital, it was suggested I schedule a cardiac echo stress-test back home to evaluate the size and function of my heart. Using all of my wisdom and experience as a physician and Professor, I did what everybody else does– find a cardiologist who would see me as a new patient and do what they suggest! The stress-test was normal. I could not have hoped for a better result nor more competent and attentive care. The question for our present exercise is: If posted standard charges were available– and I had time to look at them– what I have found? [Spoiler alert! The effort would have been a waste of time, if not misleading.] Continue reading “Mandatory Posting of Hospital Charges: Rest In Peace.”

Federally Mandated Postings of Standard Charges by Louisville Hospitals Are Unusable for Their Intended Purpose.

(But will reveal the the unacceptable and unjust absurdity of how we pay for medical services.)

Reporter Gilbert Corsey of WDRB was, to my knowledge, first on the block locally to take public look at the implementation of a newly enforced federal law requiring hospitals to publish their Standard Charges online. Originally part of the Affordable Care Act (a.k.a. Obamacared) as turned into regulation last year,, the stated purpose was to allow the public to compare the cost of services and choose wisely among hospitals before they incur responsibility for payment. An overlying expectation (?dream) was to improve quality and decrease costs. Hospitals bitterly protested implementation of this law.

Mr. Corsey’s reporting verified the expectation that charges amoung neighboring hospitals can vary greatly. For example, an uncomplicated birth at one Louisville hospital was priced twice as high as another, and an injection of a drug used for prostatic cancer varied threefold. Corsey’s report also concluded that the published lists are confusing and difficult to decipher. I agree. I will go further and argue these lists are essentially worthless for their intended consumer purpose – surely knowingly so. Their value however for unintentionally making the policy point that, like pricing for pharmaceuticals, hospital pricing and billing exists in a logic-free, Alice-in Wonderland zone to the detriment of the public. Allow me to explain. Continue reading “Federally Mandated Postings of Standard Charges by Louisville Hospitals Are Unusable for Their Intended Purpose.”