CMS has mandated healthcare providers to publish 300 services and the associated payments they receive from insurance companies on January 1, 2021. This information will give healthcare consumers an insight as to how much insurance companies pay providers. Most likely, this information will be published on their websites.
The Team at Healthcare Consumer Navigator Center (HCNC) wanted to know how easy or hard it is to navigate and find this information on providers current websites. The primary goal was to locate pricing information and secondarily to validate the following:
Ease of Use and Number of Steps required to find price information as well as availability
Quality Data and,
Charge Description Master
The HCNC Team identified 15 hospital providers throughout the country that rated as one of the top 5 facilities within their metropolitan area. Most facilities had multiple locations, surgical centers, outpatient centers and multiple physician practices. Conventional wisdom would lead you to believe that these high-profile facilities would have easy to use websites and real time information available. You be the judge.
The following is a recap of the study:
- Ease of Use; Number of Steps/Clicks required to find price information.
Average Number of steps/clicks to locatePricing: 6.6 steps/clicks on the average with a low of 4 and high of 15.
This assumes you were lucky enough to find it on the first try. Add many more; 7-10 steps/clicks if you were not lucky. Adding more is the usual process. Most consumer do not have a clue were to start on the providers home page.
HINT: ON THE HOME PAGE, LOOK FOR “PATIENT AND VISTORS” OR SOMETHING SIMILIAR; CLICK ON IT AND IT SHOULD TAKE YOU TO PATIENT INFORMATION.
- Price Information Available Real Time or Call Provider
Only five (5) providers. 33%, had real time pricing using the consumers’ insurance plan and 67% required the consumer to call the facility.
HINT: MAKE SURE WHEN YOU CALL THE FACILITY YOU HAVE ASK YOUR PHYSICIAN IF THE TEST/PROCEDURE REQUIRES PRE-CERTIFICATION AND HAVE THE FOLLOWING IN FRONT OF YOU:
YOUR INSURANCE CARD
A COPY OF THE PHYSIAN ORDER WITH THE NAME OF TEST/PROCEDURE AND HCPCS (HEALTHCARE COMMON PROCEDURE CODING SYSTEM) CODES.
- Consumer Financial Policies
HINT: MOST OF THE POLICES AND PROCEDURES THAT WERE AVAILABLE WERE INFORMATIVE AND HELPFUL TO THE CONSUMER.
- Provider Contact Information
All providers had telephone numbers of the various departments the consumer would need.
HINT: IF YOU ARE LOOKING FOR A PRICE AND WHAT YOU WOULD BE REQUIRED TO PAY, MOST PROVIDERS HAD A SPECFIC TELEPHONE NUMBER TO CALL.
- Quality Data Available
Only four (4) providers 26% had quality information available and 74% did not.
HINT: THE QUALITY DATA THAT WAS AVAIALBLE WAS LIMITED OR REFERRRED THE CONSUMER TO AN EXTERNAL WEBSITE.
- Charge Description Master Available
Twelve (12) providers 80% had Charge Description Masters available, 20% did not.
HINT: CMS REGULATIONS REQUIRE HOSPITAL PROVIDERS TO HAVE AVAILABLE THEIR CHARGE DESCRIPTION MASTER AS OF 1/1/2020. THE CHARGE DESCRITION MASTERS WERE VERY DIFFEICULT TO FIND ON TH WEBSITES. IT IS POSSIBLE THAT THE 20% THAT WERE NOT FOUND COULD BE ON THE SITE BUT WERE NOT FOUND.
- Provider Scores
The HCNC Team develop a scoring system for each provider website. Categories 1-6 above have a potential point score of 0-5, with a total score of 30 possible points. The team rated each provider as objectively as possible. The following is a summary of the scores:
30-25 3 20% A
24-20 7 47% B
19-15 5 33% C
14 and Below 0
As we asked earlier: “You Be The Judge”. If these facilities are designated as the premier facilities in their respective metropolitan areas, healthcare consumers may have a long wait to see improvements. With only 20% of the facilities receiving a A, one would like to think the scores would be higher. It is clear, consumers will continue to struggle navigating the healthcare maze.
The HCNC Team is letting you know which hospitals were included in the review. We mentioned these are highly rated organizations in their metropolitan area. We believe they are.
Also included are the plaintiffs in the lawsuit filed against Health and Human Services that are trying to block the publishing of the 300 services. NOTE: The last three (3) plaintiffs in the lawsuit were hospitals. I would suggest you review their websites; “You Be The Judge; Good or Bad”
Hospital Providers Included In the Review
Baylor Scott and White Medical Center; Grapevine, Texas
Wellstar Atlanta Medical Center; Atlanta, Georgia
Emory University Hospital; Atlanta, Georgia
Northwestern Memorial Hospital; Chicago, Illinois
Baptist Hospital of Miami; Miami, Florida
Tampa General Hospital; Tampa, Florida
Cedar Sinai Medical Center, Los Angeles, California
UC San Francisco Medical Center; San Francisco, California
Hoag Memorial Hospital Presbyterian; New Port Beach, California
New York Presbyterian Hospital; New York, New York
Cleveland, Clinic, Cleveland, Ohio
Mayo Clinic, Rochester, Minnesota TOP 3…A SCORE
Virginia Mason Medical Ctr, Seattle, Washington TOP 3 A SCORE
Vanderbilt University Medical Center, Nashville, Tennessee
Porter Adventist Hospital; Denver, Colorado TOP 3 A SCORE
Plaintiffs in the Lawsuit filed against HHS
American Hospital Association
Association of Medical Colleges
Children’s Hospital Association
Federation of American Hospitals
Memorial Community Hospital and Health Systems; Blair, Nebraska
Providence Health System; Sothern California
Bothwell Regional Health System; Sedelia, Missouri
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