Mainers can’t easily compare prices at hospitals as required by new federal law

By Caitlin Andrews, Bangor Daily News Staff

Maine patients have more access to information than ever in shopping for health care under a new federal law, but spotty compliance and confusing data layouts are still providing barriers.

Starting last January, the U.S. Centers for Medicaid & Medicare Services required hospitals last January to publish prices in a way that allows Americans to match them across hospitals, including cash prices, minimum and maximum negotiated charges, gross charges and charges negotiated with certain insurers. Hospitals went to court to try and block the law and failed.

Penalties for noncompliance can be steep, but only two U.S. hospitals in the country have been dinged as of August. More than 300 warning letters were sent out to hospitals by late July, but warnings are confidential until a penalty is issued, a spokesperson for the regulator said. 

The Bangor Daily News looked at the price transparency options included for the 36 members of the Maine Hospital Association and found that all had some consumer information available. But many appeared to be lacking information making them fully compliant, while others had entries that appeared to obscure data. 

Hospitals and their advocates say the information available is a good start in addition to a similar state law, although a national watchdog group that recently published a report critical of U.S. hospitals says any level of non-compliance is detrimental to consumers.

That depends on consumers using it first, Trevor Putnocky, spokesperson for the Healthcare Purchaser Alliance, said. Most transparency tool use rates are “abysmal,” he said, but the services they offer can be critical, especially when someone has a high-deductible plan.

“I think that as patients bear more and more of the costs, and they understand the degree to which costs vary, shopping for care will eventually become commonplace,” he said.

Missing information varied between Maine hospitals. For instance, Houlton Regional Hospital has a price shopping tool, but it does not have a discounted cash price or a breakdown of different negotiated prices between insurance carriers. Redington-Fairview Hospital in Skowhegan notes up front that it does not have cash price, minimum or maximum rates and payer-specific charges. Neither hospital responded to a request for comment.

In others, the information is obscured. Northern Light Health has files for each of its 11 hospitals as well as a price-shopping tool. But some of its columns show “######” or “N/A.” Its price-shopper only shows a cash option if a person selects the uninsured option, but Suzanne Spruce, a spokesperson for the Brewer-based system, said the first issue is an Excel issue.

Northern Light’s Eastern Maine Medical Center and Acadia Hospital were two hospitals highlighted in Patient Rights Advocate’s August report surveying compliance with the rule. It found overall that 16 percent of 2,000 hospitals, including 11 in Maine, appeared to be fully compliant. That was an increase of 2 percentage points from its February report. 

The system received a notice earlier this year that its price transparency tool was not adequately displaying information for each insurance provider listed, Spruce said. The problem has now been fixed and all of its members are in compliance with the law, she said.

While most of the Maine hospitals met several of the requirements, it deemed only two — Maine General Medical Center in Augusta and St. Joseph Healthcare in Bangor — had all the markers required by the law. The other nine hospitals examined did not.

“We need to have full compliance right away,” Cynthia Fisher, the founder of Patient Rights Advocate, who accused the nine Maine hospitals cited in the report as flouting the law.

That report dinged four MaineHealth hospitals, including the flagship Maine Medical Center in Portland, for not including enough rates in a standard file. But John Porter, a spokesperson for the system, noted CMS is the sole regulating body to determine when a hospital is not following the law and said it has not received such a notice. It was given 60 days last year to improve its file and has not had an issue since, he said.

Part of the challenge in determining compliance can be that CMS only publishes locations that have received a penalty for noncompliance, which typically comes after a written notice and a correction plan. Releasing information could prematurely identify hospitals trying to fix problems, said Raymond Thorn, a CMS spokesperson.

“CMS is encouraged by the increase in hospital compliance since implementation of the regulations last year and remains committed to continuing to work with hospitals through the enforcement process to bring hospitals into compliance,” he said.

If information does not appear available, consumers have options. A state law requires providers to divulge prices for certain services, so Mainers can inquire at hospitals. The Maine Health Data Organization offers a shopping tool for hundreds of services across the state, although they are estimates and some of the data is at least three years old.

Health care costs can be complicated and influenced by a consumer’s personal situation, said Jeff Austin, a lobbyist for the Maine Hospital Association who decried Fisher’s characterization of hospitals not in compliance. He said members are working to meet the law.

“I don’t have any concerns that we’ll get there,” he said.