How hospital price transparency falls short: 5 takeaways from our reporting
Federal price transparency rules requiring hospitals to disclose their negotiated medical care prices were implemented in 2021, but the reality has fallen short of expectations for Oregon patients.
Here are 5 takeaways from The Oregonian/OregonLive’s reporting on how hospital price transparency efforts are working — or not working — for Oregonians.
1. Hospital prices for the same procedure vary dramatically across Portland facilities.
The cost of identical medical procedures can swing by thousands of dollars depending on where they’re performed in Oregon.
For example, a C-section for a patient with Aetna insurance costs $22,617.50 at OHSU Hospital, $19,042.56 at Legacy Good Samaritan (nearly $3,600 less), and $29,700 at Providence Portland Medical Center. Similarly, a cervical spinal fusion for a Regence BlueCross BlueShield patient ranges from $45,700 at OHSU to $53,296 at Providence Portland, demonstrating significant price variations even within the same metropolitan area.
(Read our original report for interactive graphics comparing prices for more procedures, providers and insurers.)
2. Published prices rarely reflect what patients actually pay.
The price transparency data published by hospitals comes with significant disclaimers warning patients not to rely on the numbers.
The prices are shaped by confidential contracts between hospitals and insurance companies, varying based on plan, provider network and even time of year.
Keith Ericson, a health economist at Boston University, noted that “the prices you see online almost never match what actually shows up on a patient’s bill.” That leaves patients with little information about costs until after they receive care.
3. Implementation of transparency rules has been inconsistent, and observers say enforcement has fallen short.
Despite federal requirements, many hospitals have failed to comply with price transparency rules.
A November federal audit revealed nearly a third of sampled hospitals weren’t in compliance, even after President Biden authorized fines of up to $5,500 per day for non-compliance. Experts like Vivian Ho from Rice University criticized the quality of disclosures, stating “the hospitals are just cranking out garbage” with incomplete and difficult-to-compare pricing files.
The lack of standardization across hospitals makes meaningful price comparisons nearly impossible for consumers, effectively undermining the purpose of the transparency initiative.
4. Oregon lawmakers are considering state-level transparency legislation.
Oregon Senate Bill 1060 would codify federal hospital price transparency rules and standardize how pricing information is disclosed within the state. Consumer advocates support the bill, arguing that with patients bearing more health care costs through deductibles and co-pays, clear pricing is essential.
However, the Hospital Association of Oregon — which represents the state’s hospitals — opposes the legislation, warning it would impose “costly, confusing, and unnecessary requirements” on already financially strained hospitals, particularly in rural areas.
The bill has been weakened through amendments that removed enforcement mechanisms and patient rights to sue for disclosure. And in the waning days of the legislative session, the odds it will become law are shrinking.
5. Price transparency alone doesn’t solve health care decision-making challenges.
Even with perfect implementation, price transparency wouldn’t address all health care decision-making challenges.
Reliable information on hospital quality remains difficult to find, making it impossible to compare providers based on both cost and outcomes, said health economist Vivian Ho, adding that higher prices don’t necessarily indicate better care.
Meanwhile, Oregon health costs continue to rise faster than wages, with per-person spending reaching $10,300 in 2023 (up 8% from the previous year), and 15% of Oregonians reported delaying or avoiding care due to costs while 83% worried about affording health care in the future.
Generative AI was used to summarize reporting from our Friday story. These takeaways were reviewed and edited by The Oregonian/OregonLive.
link
