Kaitlyn Finley | July 6, 2021
Many Oklahoma hospitals not compliant with price transparency law
An analysis of Oklahoma hospitals found less than half of hospitals are compliant with new federal price transparency rules.
As of January 1, 2021, hospitals must provide price information for their services online in a machine-readable file, according to the Centers for Medicare and Medicaid Services. For applicable service items and procedures the standard charges should include “gross charges, discounted cash prices, payer-specific negotiated charges, and deidentified minimum and maximum negotiated charges.”
Hospitals must also disclose the prices for 300 common procedures or provide patients with an online consumer-friendly price estimator tool. According to the federal rule, hospitals that don’t comply with the price transparency rule may be charged up to $300 per day for multiple policy violations. Hospitals that are federally operated or owned by an Indian Health Program are not subject to the new price transparency rules.
A recent poll from the Kaiser Family Foundation found that many Americans are not aware hospitals must post prices online. “About one in ten (9%) are aware hospitals are required to disclose the prices of treatments and procedures on their websites,” reported Kaiser.
I recently reviewed all public Oklahoma hospitals’ websites to see which hospitals were compliant with the federal rule. In my analysis I did not include rehabilitation centers, hospitals owned by an Indian Health Program, or federally owned hospitals.
Of the 107 applicable public hospitals reviewed, fewer than half (49) of the hospitals were fully compliant with both parts of the price transparency law. Forty-five hospitals were partially compliant and provided access to their standard charges or included a consumer-friendly price estimator tool. Thirteen hospitals did not provide any price transparency data on their websites. [This is an ongoing project and the data source, this Google sheet, will be updated regularly. Price estimates are subject to change. If you see an error or would like to provide an update to the spreadsheet, please email email@example.com.]
Below is an example of a version of a consumer-friendly tool that some hospitals used.
Source: Arbuckle Memorial Hospital
However, the prices that are given from this consumer-friendly shopping tool may not be a complete estimate of service.
Before receiving a price estimate, some hospitals include a disclaimer that states the estimate may not include the professional fees for the physician, surgeon, radiologist, pathologist, anesthesiologist, or nurse practitioner. The price estimate may be just the hospital facility fee. Providers involved may bill the patient separately.
Among the hospitals reviewed, there was a wide price variance for a gallbladder removal surgery (laparoscopic cholecystectomy), with prices ranging from $1,365 to $38,629. However, it is important to note that some estimates may not reflect the final price.
Depending on the location, some hospital systems will charge a different amount for the same service. For instance, the price for a gallbladder removal at Integris Hospital in Miami will cost an uninsured patient $24,656; at Integris Baptist in Oklahoma City the procedure costs $38,629, according to their price estimator tool.
Other procedures have a wide price variance as well. For instance, in Oklahoma City, a cataract surgery may cost a patient and their insurer (or employer) anywhere from $2,066 to $17,647, depending on different negotiations.
Sources: Healthcare Bluebook; The Kempton Group
Legislation proposed last session by state Senator Julie Daniels (R-Bartlesville) would have encouraged medical providers to provide a good-faith estimate to patients prior to the medical service. Senate Bill 548 passed the Oklahoma Senate but failed to pass the House.
Given the high price variance for medical services and lack of online price transparency, it’s imperative that patients have the ability to receive a tailored quote from their providers and insurers if applicable before care is given.
Policy Research Fellow
Kaitlyn Finley currently serves as a policy research fellow for OCPA with a focus on healthcare and welfare policy. Kaitlyn graduated from the University of Science and Arts of Oklahoma in 2018 with a Bachelor of Arts in Political Science. Previously, she served as a summer intern at OCPA and spent time in Washington D.C. interning for the Heritage Foundation and the U.S. Senate Committee on Environment and Public Works.