The New Year begins with new laws, including one that could help you make more beneficial choices when it comes to health care.
Hospitals are now required to post prices for their services online thanks to a new requirement from the Centers for Medicare and Medicaid Services (CMS).
“It's really not even a new law. It's more of a clarification,” said Brian Potter, Senior VP of Finance at the Wisconsin Hospital Association. “The ACA, when that started, the Affordable Care Act under Obamacare, had a transparency requirement in it, so this is more clarification because there was some confusion on what hospitals had to do.”
The law that went into effect on January 1st requires hospitals across the country to post their prices online, but it's not necessarily like a pick-and-choose menu.
“Each hospital has to report the chargemaster in a machine-readable format, so like an Excel spreadsheet,” said Potter. “So when you think about a consumer and how they might use this information I'm not sure they want to go to a spreadsheet and try to recreate what an event at a hospital, for example, might cost.”
Wisconsin has a state mandate to collect hospital billing information, so there is quite a robust database. For more than a decade, the Wisconsin Hospital Association has used that information to operate its website called PricePoint.
“What PricePoint does is it actually groups things into things like a knee replacement,” said Potter. “So it doesn't have every line of a bill for a knee replacement. It has, on average, for that episode of care in the hospital what that average knee replacement would cost in terms of charges and then the website would allow you to then go and pick as many hospitals as you wanted to compare and see them all in an apples to apples comparison.”
Spectrum News 1 used PricePoint to find out how just much medical prices really vary across the state.
For example, the median price for a knee replacement in Wisconsin is $43,114. The same surgery that would cost you $47,113 at UW Hospital in Madison would cost $30,580 at Mayo Clinic Health System in Eau Claire and $38,716 at Aurora BayCare Medical Center in Green Bay.
“It does allow you to shop around, and particularly for those people that may be paying out-of-pocket or have more of an indemnity plan that might allow them to go anywhere in the state, you would certainly want to use that for that particularly as it impacts your out-of-pocket,” said Potter.
Currently, 10 other states contract with Wisconsin to operate similar healthcare transparency websites. Now, with the recently enacted rule by CMS, more states could implement similar transparency systems.
The Wisconsin Hospital Association also has a sister website called CheckPoint, which allows patients to look up quality scores for hospitals across the state.