The websites of 75 percent of the nation’s 115 biggest hospitals required three or more clicks to find their chargemaster, according to an analysis by Quartz.
Five things to know:
1. As of Jan. 1, hospitals are required to post their standard charges online under a CMS price transparency rule. They must present the information in a machine-readable format that can be easily imported into a computer system and update the information at least annually. On Jan. 10, CMS Administrator Seema Verma acknowledged that the information hospitals are posting “isn’t patient-specific,” but she said the federal government still believes the requirement “is an important first step.”
2. For its analysis, Quartz surveyed the websites of 115 of the largest U.S. hospitals, which receive 20 percent of all Medicare and Medicaid hospital funding. The reporters said “after spending an inordinate amount of time clicking through pages,” they found 105 hospitals’ lists online.
3. “Even among those hospitals that are technically compliant with the new rule, the vast majority don’t make it especially easy for the average person to find their pricing information. We found that most price lists are buried under many sub-menus or at the very bottom of a long page scroll,” the reporters said.
4. For six hospitals the reporters had trouble finding price lists for, they were able to track them down through a Google search pairing the name of each hospital with phrases like “price list” or “chargemaster.” Another four hospitals whose lists remained elusive to the reporters were contacted via email or phone, with three — Hackensack (N.J.) University Medical Center, Allentown, Pa.-based Lehigh Valley Hospital and Washington Hospital Center in the District of Columbia — not replying to Quartz at the time of writing.
5. Even for hospitals whose online lists were more accessible, some required hundreds of clicks to find a particular item, according to the publication. For example, Louisville, Ky.-based Norton Hospital’s 1,560-page price list had three separate pages for “treatment rooms.” At least five hospitals also requested a user’s email and name to access the data.
“In many instances, the price list is published on illogical pages. Most hospital sites have a ‘billing’ section, but, for example, the Methodist Hospital in San Antonio decided to put its standard rates on the legal page while [Indianapolis-based] Indiana University Health has placed it under the Frequently Asked Questions section of its website. Baptist Hospital in Miami published their chargemaster as fine print,” according to Quartz.
For the full Quartz report, click here.
The Supreme Court was expected to hear oral arguments today over notice and rulemaking requirements for Medicare reimbursement.
The outcome of Azar vs. Allina Health Services could greatly affect reimbursement for hospitals that serve a disproportionate share of low-income patients. The DSH payment calculation is based on the percentage of low-income patients served.
The government wants to add Part C, or Medicare Advantage beneficiaries into the calculation, a move hospitals fear would decrease payments based on their belief that MA members are, on average, wealthier than Medicare Part A beneficiaries.
But the lawsuit is about how the Department of Health and Human Services went about attempting to implement its rule.
The hospitals in the lawsuit argue that HHS is required to conduct notice and comment rulemaking before providing the instructions to a Medicare administrative contractor that makes the initial determinations of payments due under Medicare. Medicare uses private contractors to administer its reimbursements to providers.
The case went to the District of Columbia Circuit Court, which vacated the rule. The hospitals argue that after the circuit court’s decision, CMS simply tried to make the same change without undertaking notice and comment.
The judge in the District of Columbia Circuit Court case was Brett Kavanaugh, who as Supreme Court Justice, is recusing himself in the HHS case Azar vs. Allina Health.
WHY THIS MATTERS
CMS’s proposed rule changes affect hundreds of millions of dollars in reimbursement for hospitals. The government estimates that the DSH payments from 2005 to 2013 totaled $3 to $4 billion, according to SCOTUSblog.
Hospitals suing HHS said the Centers for Medicare and Medicaid Services “botched” attempted rulemaking in 2004, when the department tried to change the standard governing Medicare payment to hospitals nationwide for services furnished to low-income patients.
The Medicare Act requires the agency to engage in notice-and-comment rulemaking, the hospitals argue.
HHS disagrees, saying the Medicare Act does not require HHS to issue formal notice-and-comment rulemaking prior to changing the DSH calculation formula. Doing so would cripple the Medicare program, requiring the agency to use rulemaking for any change in its lengthy and detailed operations manuals, it argues.
The hospitals involved in the lawsuit are Allina Health System and its affiliated hospitals, Abbott Northwestern, United, and Unity; Florida Health Sciences Center; Montefiore Medical Center; Mount Sinai Medical Center, New York-Presbyterian/Queens; New York Presbyterian Brooklyn Methodist Hospital; and New York and Presbyterian Hospital.
ON THE RECORD
“The agency botched that rulemaking: the final rule was not the ‘logical outgrowth’ of the proposed rule, and the D.C. Circuit vacated it,” Allina and other health systems said.
HHS Secretary Alex Azar said in court documents, “As the government has explained, respondents’ theory, if adopted, has the potential to substantially undermine effective administration of the Medicare program, not least because its rationale would encompass not just the Medicare fractions at issue here but nearly every instruction to the agency’s contractors, including those contained in the Provider Reimbursement Manual.”
The California healthcare firm that owns both Hahnemann University Hospital and St. Christopher’s Hospital for Children has combined leadership of the two well-known Philadelphia institutions under one new chief executive.
Paladin Healthcare created a new affiliate, American Academic Health System, to own and operate Hahnemann and St. Christopher’s. A memo sent to staff this week said that Southern California hospital executive Suzanne Richards took over as CEO for both hospitals Monday, according to the Philadelphia Inquirer.
Neither of the previous CEOs, Hahnemann interim CEO Anthony Rajkumar or St. Christopher’s leader George Rizzuto, were mentioned in the memo, the report said.
Hahnemann University Hospital is a 496-bed academic medical center affiliated with Drexel University School of Medicine. St. Christopher’s staffs more than 220 pediatric experts and offers both general pediatric care and pediatric specialties including cardiology, ear, nose and throat, gastroenterology, oncology and orthopedics, as well as one of only three Level I pediatric trauma centers in Pennsylvania and the only pediatric burn center in the Philadelphia area.
The hospital also touts an expansive primary and specialty care network that reaches into the Philadelphia suburbs and New Jersey.
The Inquirer report said this is one in a line of management changes American Academic has made since it acquired Hahnemann and St. Christopher’s from Tenet Healthcare in September.
In August, St. Christopher’s laid off 45 people in its physician practices and eliminated an unspecified number of positions also in its physician practices, which amounted to roughly 7 percent of the workforce in the hospital’s practices. Quoting a hospital spokesperson, the report said those being laid off were given severance or offered positions at other American Academic Health System facilities.
Paladin Healthcare formed AAHS to own and operate academic medical centers and general acute care hospitals across the country. Paladin currently manages four Southern California general acute care hospitals as well as the 145-year-old teaching hospital Howard University Hospital in Washington, DC.
Tenet netted roughly $170 million from the sale of Hahnemann and St. Christopher’s, comprised of $152.5 million in cash at closing and a promissory note in the amount of $17.5 million.
ON THE RECORD
At the time of publishing, requests for comment made to Hahnemann, St. Christopher’s and American Academic Health on the change in leadership had not been returned.
On the sale of Hahnemann and St Christopher’s to Paladin/American Academic: “Our leadership team has extensive, first-hand experience in operating hospitals in the Philadelphia market and understands the vital role Hahnemann and St. Christopher’s play in the Philadelphia healthcare delivery system,” said Barry Wolfman, president of Paladin Healthcare. “We appreciate Drexel University College of Medicine’s support and look forward to working closely with the entire physician community to continue the longstanding clinical and academic excellence of both hospitals.”