Chargemaster

Abstract: Background In January 2019, the Centers for Medicare & Medicaid Services (CMS) required hospitals to list their standard charges (chargemasters) publicly in an effort to increase price transparency in health care. Surveying hospital chargemasters may be informative to assess the implementation of this rule and its utility to consumers. Objective We aimed to compare hospital chargemaster data within a local hospital market where patients would reasonably try to shop or compare services. Methods We identified and aggregated Dallas County hospital chargemasters available in a database compatible format in May 2019. We manually examined a convenience sampling of 10 common laboratory tests, medications, and procedures. Results Thirteen hospital chargemasters were identified. Eleven hospitals had chargemasters available in a database compatible format (xlsx or csv). These 11 chargemasters were aggregated into a single file containing 155,576 chargeable items, prices, and descriptions. We observed heterogeneous names and descriptions of synonymous items across institutions, preventing automated comparisons. The examined items revealed a high variation in charges. The largest charge variation for laboratory tests examined included a 2,606% difference (partial thromboplastin time: $18.70–506.00), for medications an 18,617% difference (5-mg tablet of amlodipine: $0.23–43.05), and for procedures a 2,889% difference (circumcision: $252.00–7,532.10). One institution accounted for 27% of the lowest prices and another accounted for 60% of the highest prices. Conclusion Chargemaster data presentation varied among the hospitals surveyed, making automatic comparison impossible. Chargemaster data are difficult to interpret for health care decisions. Refining the minimum requirements for publishing chargemaster data could increase their utility.

Abstract: On August 2, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a final rule (CMS-1694-P) that they hoped would provide patients and caregivers better access to hospital pricing information with the goal of achieving greater price transparency in the provision of healthcare.1 As of January 1, 2019, hospitals will be required to “make available a list of their current standard charges via the Internet in a machine readable format and to update this information at least annually, or more often as appropriate. This could be in the form of the chargemaster itself or another form of the hospital’s choice, as long as the information is in a machine readable format". CMS believes that this will promote price transparency by improving public access to hospital charge information. In language from the same final rule, there is tacit acknowledgment of the many comments CMS received that were clearly concerned about this change. They (CMS) indicate an awareness of the challenges that continue to exist because, for example, the chargemaster data may not accurately reflect what any given individual is likely to pay for a particular service or visit. Additionally, the comments argue that the chargemaster data would not be useful to patients because it is confusing as to the amount of the actual out of pocket costs imposed on an individual patient. CMS insist that they are considering ways to further improve the accessibility and usability of the information disclosed by the hospitals. Cloaked in the simplicity of this disclosure request are various complex issues. As a result, CMS issued a frequently asked question (FAQ) sheet in late September 2018. In this FAQ sheet, CMS clarified that the requirement for transparency applied to all items and services provided by the hospital. CMS further encouraged hospitals to undertake efforts to engage in consumer friendly …