Nontransparent transparency: Price lists from HCA, a for-profit chain

Filed Under: Costs, Health plans, Patients

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When is transparency not really transparent?

First: Whenever anyone does anything furthering the cause of transparency, we applaud.

So when HCA Holdings, the nation’s largest for-profit hospital chain, publishes price information, it’s easy to get excited.

HCA, you remember, was the subject of a two-part series in The New York Times in August 2012 — here’s one of the pieces —  pointing out that the chain was bought by private equity firms in 2006 and that in the intervening six years, financial successes had brought the purchasers “holdings to nearly three and a half times their initial investment in the $33 billion deal.”

“Among the secrets to HCA’s success: It figured out how to get more revenue from private insurance companies, patients and Medicare by billing much more aggressively for its services than ever before; it found ways to reduce emergency room overcrowding and expenses; and it experimented with new ways to reduce the

cost of its medical staff, a move that sometimes led to conflicts with doctors and nurses over concerns about patient care,” wrote the reporters, Julie Creswell and Reed Abelson.

HCA said that all its decisions were motivated by a desire for better patient care.

If you go to the main site at HCA, you’ll find a pricing information page that offers a menu for hospital locations, then give charges for standard treatments, for cash patients and for insured patients. The chain has more than 160 hospitals in 20 states.

This apparently is not new; I found an online post from 2007 explaining that HCA was embracing transparency, and trumpeting it as a great move. So … let’s take a look. Here’s just one item.

At Presbyterian/St. Luke’s Medical Center & Rocky Mountain Hospital for Children in Colorado, a “C-Section Delivery of a Newborn:Delivery of single live-born infant newborn through an abdominal incision (Cesarean section).” costs $2,095 – $3,078 and a “Single Liveborn Born in Hospital by Cesarean Section – Baby’s Stay:Newborn delivered by cesarean section”  is priced at $691 – $12,393. (Boldface is ours.)

At Terre Haute Regional Hospital, the delivery costs $4,868 – $5,921 and the baby’s stay will run $892 – $1,212.

In Oklahoma, at the OU Medical Center, the delivery is $2,997 – $4,518 and the baby’s stay $1,014 – $5,714.

At Doctors Hospital of Sarasota, there’s no price estimate for a C-section childbirth.

At Dauterive Hospital in Louisiana, the financial information page gave an error message; same at Alaska Regional Hospital and Riverside Hospital in California.

So the information is visible,  at least sometimes, but is it meaningful? Is this a great move for transparency?

It reminds us a bit of when Kathleen Sebelius, the Health and Human Services secretary, released a number of prices charged to Medicare, calling it price transparency. But is it really transparency?

The HCA Policy apparently dates back to at least 2007, and it includes all sorts of disclaimers:

“Terre Haute Regional Hospital has a Charity Discount Policy that provides free hospital care for patients who have received non-elective care, do not meet the qualifications for Medicaid and whose income is less than 200% (in most cases) of the Federal Poverty Level,” the Terre Haute site says. In order to qualify for this free care, you must complete a Financial Assistance Application and provide some documents to support your income. To access our full Charity Discount Policy, click here.

“For patients who do not meet the Charity Discount Policy criteria and will be expected to pay for services out of pocket, Terre Haute Regional Hospital offers a managed care-like discount. All Uninsured patients (excluding those receiving cosmetic procedures and certain ‘package’ procedures) will be given an Uninsured Discount. To access our full Uninsured Discount Policy, click here. All pricing estimates posted below already reflect the hospital’s uninsured discount.”

Meanwhile, to even get to the pricing, you need to accept this statement, by either clicking “I Understand” or asking for more information:

“Terre Haute Regional Hospital makes no guarantees regarding the accuracy of the pricing information provided by this website. A final bill for services rendered at Terre Haute Regional Hospital may differ substantially from the information provided by this website, and Terre Haute Regional Hospital shall not be liable for any inaccuracies.”

First, I want to repeat: any transparency effort gets praise from us. But if it’s transparent but not meaningful,  then what is it?

By the way, it’s great to have a posted charity and uninsured payment policy, so we’re totally on board with that.

And yet: the prices are given in ranges so wide as to be meaningless. This range — $691 – $12,393 — isn’t very revealing. For other procedures in other places, the prices are similarly wide.

What we’d like to see:  break the prices down into constituent parts. Explain the differences between the $691 version and the $12,393 version. Make comparative charts showing prices in various hospitals in, say, other hospitals in Colorado. Compare them to other options, including the charity price, the full-freight price, and the price of, say, a doula home birth.

Parenthetically, HCA also came in for criticism in the New York Times series for unnecessary treatments — specifically, performing heart treatments on patients who didn’t need them, and endangering their lives. HCA was also criticized for instituting a policy in the emergency room “not to treat patients who came in with nonurgent conditions, like a cold or the flu or even a sprained wrist, unless those patients paid in advance,” The Times reporters wrote. So if you don’t know what goes into the $691 version and the $12,393 version, how do you know what you’re buying?

What we’d recommend:

From the hospital chain, real transparency, so patients — or consumers, or people, as we’re fond of calling them — can make real decisions based on real, actionable information.

From people considering HCA hospitals, asking real questions about real prices.