Since ancient times, one of the primary tenets of medicine has been that physicians should “First, Do No Harm” to our patients. Today, we also need to add “Do No Financial Harm.” The best way to do that, and to protect our patients’ finances is through complete price transparency.
The ability to see and compare prices would usher in price competition, which would bend the cost curve down for a change, allow patients to shop for the best value for their health-care dollar, and slow the unhealthy trend of consolidation in the health-care industry.
Thankfully, as of the first of this year, a new hospital price transparency rule went into effect, giving Americans the right to know the price of their health care upfront.
The problem is that many hospitals throughout our state are not complying with the federal law. A report released last month by a national nonprofit organization showed that the vast majority (94.4%) of hospitals, including most of those in Maine, were not following the rule.
They claim that they cannot comply because the information is not readily available, which insults the intelligence of the average Mainer. All these hospitals have multimillion dollar billing systems that can, and do, generate bills to patients and insurance companies on demand. We all see the prices in the explanation of benefits we receive ─ after we get health care we cannot return. Obviously, they know the prices, but are unwilling to disclose them. There is no reason that, upon request, hospital billing personnel couldn’t enter the procedure code of a particular service (called a CPT code), and display the price the hospital charges in advance. If hospitals really cannot do this, perhaps there should be intense audits of their accounting systems.
Although doctors are often blamed for rising health-care costs, I assure you, we want what patients want. We want to know prices, too, but hospitals and insurers also keep us in the dark. That has always been unethical, and now it is criminal.
I have written to Maine Attorney General Aaron Frey asking him to help enforce the law and hold hospitals accountable. To do that, our government needs to dramatically increase the financial penalties imposed on hospitals that don’t follow the rule. Currently, the penalty is only $300 a day. Worse, the government has yet to fine a single hospital for not complying with the government’s own rule. What good is a law with no teeth? The fine should be ten times that, or $300 a day per hospital bed, and be robustly enforced. We also need to eliminate the loophole in the rule that allows hospitals to simply provide estimates, not guaranteed prices. By their complacent inaction, government is sending the message that these hospitals, most of which are nonprofit, so don’t pay taxes, are above the law. Perhaps the State of Maine should re-examine the tax-exempt status of any hospital system that doesn’t comply with this very important consumer protection.
We have a long way to go to fix our broken health-care system, but demanding what is rightfully ours, the right to know the cost of care before getting a surprise bill, is an essential step. Mainers deserve nothing less and should demand nothing less.
— Special to the Press Herald
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