, Muskogee, OK

February 1, 2014

Hospital price lists may be required

Most would have to post prices under state bill

By D.E. Smoot
Phoenix Staff Writer

— A bill that would require most Oklahoma hospitals and surgical centers to publish price lists for the most common medical and imaging procedures is drawing mixed reactions among health care providers.

District 14 Rep. Arthur Hulbert said the measure would provide transparency for patients who typically have no idea about the cost of their medical care until the bill arrives. The Fort Gibson Republican said that transparency would spur competition drive down health care costs.

“The health-care industry is the only industry I know of where the consumer is not aware of the costs of the goods or services before they access them,” said Hulbert, a physical therapist. “If an individual is required to assume financial responsibility of a procedure, they should have some idea what the costs will be ahead of time.”

The Oklahoma Health Care Cost Reduction and Transparency Act of 2014 would affect all hospitals and surgical centers that bill Medicaid for medical procedures performed. The affected facilities would be required to provide lists for the full costs for procedures that would be borne solely by a patient if no third party assumed a portion of the charges and amounts that would be reimbursed by Medicaid or Medicare.

Those figures typically aren’t available to would-be patients who want to compare prices, but there are some exceptions. Mike Gilpin, marketing director for EASTAR Health System, said the Muskogee hospital provides the anticipated costs of a surgical procedure to a “patient at the time of registration.”

“The anticipated cost is based upon a routine procedure, and if we have the patient’s insurance information, then we will be able to provide the cost of co-payments,” Gilpin said, noting hospital executives have yet to stake out a position on House Bill 2400. “And if somebody contacts the hospital, we will provide them with the same information with regard to anticipated costs.”

While EASTAR will provide information about costs upon request, the Surgery Center of Oklahoma voluntarily publishes information Hulbert’s bill would make compulsory for most hospitals and surgical centers in the state. Dr. G. Keith Smith, medical director for the Oklahoma City surgical center, said the facility began almost five years ago publishing the costs of its surgical procedures as part of its business plan.

The reasoning behind the decision, Smith said, was threefold. He and his partners wanted uninsured patients or those with high-deductible policies to know affordable surgeries are available and to prove a point. They also wanted “to expose those who claim ‘not-for-profit’ status and who charge 10 times what we do.”

“This conversation, the one we had hoped for, has begun,” said Smith, who believes government intervention could do more harm than good. “Many surgery centers, imaging centers and even hospitals are doing this — the vast majority are owned and controlled by physicians, this arrangement eliminating the most greedy profit-seeker in the health-care equation: the corporate hospital.”

Smith, whose facility would be exempt from Hulbert’s bill because it does not bill the Medicaid system, said they have seen patients from across — and outside — the country since they began publishing surgical costs.

“The first patients to arrive were Canadians, realizing they could buy their way out of long lines for reasonable amounts,” Smith said. “Many patients have told us we have spared them bankruptcy, as their next best price was many times what we charged them.”

Smith agrees with Hulbert that price transparency and competition would drive down the costs of health care and put an end to hospital “cartels” that “are raking in the dough.” But he fears government intervention will undo what already is beginning to take shape in the marketplace.

“I have said many times that the only thing that could possibly derail the price transparency movement in health care in this country is for the government to endorse it,” Smith said, stopping short of questioning Hulbert’s intentions. “The market is forcing hospitals all over the country to face their non-transparent ways and will not forgive those who try to fudge.”

Smith said HB 2400 “opens the door for legislators to sell exemptions” or “re-define transparency” in a way that would allow corporate hospitals to “wear the transparency label while providing little or no actual transparency.”

Hulbert said his bill is about the rights of patients, and he would oppose exemptions in favor of transparency in the marketplace. The costs of surgical procedures, Hulbert said, is just one variable.

“Before a patient signs a line assuming financial responsibility for a procedure, they should know the cost of what they are paying for,” Hulbert said, noting price is just one of several factors like infection rates and clinical outcomes a patient should consider when choosing a surgical care facility. “They (hospitals) already do this for insurance companies, so why won’t they do it for their patients?”

Reach D.E. Smoot at (918) 684-2901 or