“I don’t think it’s going to be very effective as it is right now,” Carrera said. “There’s a long journey to improve these (pricing) requirements.”
The primary issues are a lack of standardization in what hospitals are required to report and arbitrary regulations set by CMS.
With multiple components to the total charge from facility charges to physician charges to supplies, there is no clear template on how to define a price or how prices should be posted, Carrera said. Rather, defining hospitals fees is open to interpretation.
St. Vincent Healthcare’s cost calculator estimates a patient without insurance would pay $1,546 for a CT scan of the pelvis. The estimate lists contrast medications for imaging as included in the total, but does not include professional charges for the radiologist or lab work, despite requirements from CMS that hospital fees must be included in the estimate.
Billings Clinic estimates the out-of-pocket cost for the same procedure without insurance would be $1,651. Professional fees are included in the Billings Clinic estimate, totaling $273 and other hospital charges coming to $1,378. It is not clear what is included in the hospital fees, or if the discount for uninsured patients is factored in.
CMS defines hospital fees as “any item or service a hospital customarily provides as part of or in conjunction with a shoppable primary service” on a guiding document for hospitals. This could include laboratory, radiology, drugs, delivery room, operating room, including post-anesthesia and postoperative recovery rooms, therapy services such as physical, speech, occupational, hospital fees, room and board charges or charges for employed professional services.