How much do hospitals charge for care?

GAO report finds legal, technical obstacles to price reporting

Price availability for medical treatment varies widely across organizations, according to a recent Government Accountability Office (GAO) report, which noted that hospitals face several reporting obstacles.

The report analyzed eight government and private initiatives that provide price information to health care consumers before treatment. It found that clinical uncertainties presented significant barriers to providing price estimates.

For example, GAO found that some physician's offices only could provide screening test prices after a patient underwent an exam to determine whether the test was necessary. Similarly, hospitals asked to estimate the cost of knee-replacement surgery said they could do not do so without knowing detailed clinical information, such as how much time a patient spent in the OR, the type of knee and anesthetic used, and the billing code.

The report also indentified insurance obstacles to price availability. For instance, the cost of a service can depend on a patient's insurance plan and how much they already spent toward the plan's deductible. In addition, GAO noted that provider barriers to price availability can occur when a provider considers his or her price data to be proprietary information. Contractual obligations between insurers and providers also may prohibit the disclosure of negotiated rates.

According to the report, the obstacles to price availability present "a serious challenge for consumers who are increasingly being asked to pay a greater share of their health care costs." GAO urged HHS to assess the feasibility of directly providing estimates to consumers (Radnofsky, "Health Blog," Wall Street Journal, 10/24; Daly, Modern Healthcare, 10/24 [subscription required]; AHA News, 10/24).


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