Gina Hamilton

Gina Hamilton

As reported last week, according to both LD 1760 and LD 1642, hospitals and health care providers are supposed to provide information about the cost of the procedures patients are expected to undergo, and in order for patients to cost compare for procedures that aren’t emergencies, they are told to go to a website,

LD 1642, for instance, says this: “A health care entity shall prominently display in a location that is readily accessible to patients, information on the price transparency tools available from the publicly accessible website of the Maine Health Data Organization, established … to assist consumers with obtaining estimates of costs associated with health care services and procedures.”

Both laws went into effect on August 1. There is just one problem — the website won’t be ready for prime time until September — a year from now.

The reasons are complex, but what it boils down to is that there is a lot of data that comes in, every six months, and no two hospitals bill alike, so trying to sort out what codes mean is virtually impossible. Karynlee Harrington, acting executive director of Maine Health Data Organization, says that the methodology is being revamped, and so are the types of information the system will one day be able to provide. “I believe that health care quality is just as important as cost,” she said. “Right now, the website doesn’t allow us to show that kind of information.”

But even just the cost portion is difficult, she said. “Hospitals code things differently. Even things that should be easy to see, a straight comparison, may be done differently from one facility to the next. Our methodology requires a professional cost and a location cost. If a bill flows through without one or the other, we don’t include it, even though the hospital might be coding the two costs together.”

For instance, imagine a traveling mammogram van that visits senior centers and shopping malls across Aroostook County. Perhaps the company that operates the van codes for only one charge — the technician who performs the mammogram and the doctor who reads it — and lumps the cost of the van and machine into the professional charge. In a case like that, MHDO wouldn’t average that charge in.

Harrington is hoping for a second federal grant to help with the work that needs to be done around the issues of methodology and consumer expectations. If they receive the second grant, which will be over a million dollars, they hope to have all the work necessary done by September of next year.

“As much as I would like to see more data on the site,” Harrington said, “it’s more important for the data we have to be accurate.”

Senator Geoff Gratwick, who is also a doctor in Bangor, sponsored one of the bills (Senator Richard Woodbury sponsored the other). He was dismayed to learn that the MHDO website was not fully operational, but not entirely surprised. “They’re trying to do some difficult work on a shoestring budget,” he said. He, too, would like to see quality addressed, and emphasized that higher quality doesn’t always mean a higher price.

Still, he said, hospitals should be offering that information. The law as written directs hospitals to provide that information upon request. This is more complex for patients than going to a website and doing an instant comparison, but it is at least something more than what patients had been getting prior to these laws going into effect.

When we called Parkview and Mid Coast Hospital to get information on the costs of a digital screening mammogram and a bone density test, we were told we would be called back. Parkview transferred us to the Lewiston office of Central Maine Medical Center, who were able to price one of the tests immediately — their digital mammogram was $273, with an extra charge for a radiologist reading the result. We were unable to get that information from them, and had to call a third party who was out of the office. CMMC said that Parkview would get back to us Monday with the cost of the bone density test. Mid Coast called back a few minutes later with the cost of the mammogram ($262) and the bone density test ($161). They did not say whether the mammogram included the reading by the radiologist.

Neither hospital referred us to the website, although signs are posted inside the hospital registration areas that reference the site.

In short, the information is available, although it may take time to get it, and patients have to have some degree of medical savvy to understand what they are asking for and how to find the right person in the hospital to ask. Some hospitals have a person in the billing department handle calls like this; others have a patient advocate or medical information specialist who handles that information.

These prices are the prices that would be charged to patients without insurance. In some cases, insured patients would get a better deal, because some insurance companies make deals with specific hospitals for services. In other cases, insured patients would be paying more. Because the costs for insured patients are all over the board, the laws specify the uninsured prices must be offered.

It appears that our local hospitals are doing their best to live up to the letter of the law, especially in light of the fact that the website is not yet ready for action.

Gratwick’s nursing students are calling hospitals this fall to see how many are following the new law. “If we find they aren’t, we’ll have to tighten up the regulation in the next session,” he said. “The [Woodbury] bill about notifying patients about the MHDO website was not intended to be a way for hospitals to wriggle out of their obligations to provide information to the consumers themselves.”

The takeaway message here is that there are a lot of moving parts to this puzzle, and the best intentions in the world don’t make the complex data sets more comprehensible. But the two bills that went into effect in August are an impetus toward the goal, which is to provide transparency for patients and providers alike. Perhaps a year from now, that goal will be more fully realized.

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