In August 2021 I reviewed Madison hospitals’ compliance with the Federal “Hospital Price Transparency Final Rule,” which requires hospitals to make their standard charges readily available to the public, in both “consumer-friendly” and “machine-readable” formats. Hospitals have now had an additional five months to come into compliance, and it’s time for an update to see how local hospitals are doing.
The current review method is similar to the prior report, with searches on the websites of the three main hospitals in Madison (SSM Health St. Mary’s, UnityPoint Meriter, and UW Health University) for availability of both formats, particularly for the the six behavioral health services required to be reported among 300 “shoppable services,” (defined as “a service that can be scheduled by a health care consumer in advance”).
A checklist was designed for the site reviews based on CMS guidance (“10 Steps to Making Public Standard Charges for Shoppable Services,”) including six required criteria. Since the price of health services – particularly psychotherapy – is often hidden to consumers seeking care, when these prices were located through this review, prices are listed here for the six key behavioral health services: individual therapy in 30, 45, and 60 minute increments, family therapy with and without the “identified patient” present, and group therapy.
Results
None of the three hospitals were in full compliance with the transparency rule in August 2021 (See Table 1). None are in full compliance at this time. A few improvements are noted. Prices when available appear to be quite variable. Easy access by consumers to the cost of therapy at these three hospitals remains elusive. Gaps also continue in availability of quality measures related to therapy as well as financial assistance information in languages other than English that are likely to occur in local communities.
2022 SSM Health St. Mary’s Hospital – Madison
https://www.ssmhealth.com/locations/st-marys-hospital-madison
COMPLIANCE CHECKLIST
| CRITERION | 2022 | 2021 | NOTES |
| Comprehensive machine-readable file | Yes | Yes | json format |
| Consumer-friendly display of standard charges for at least 300 ‘shoppable’ services grouped with charges for ancillary services that are customarily provided by the hospital (see Alternative Checklist) | Yes/No | Yes | Initial search straightforward by link from ‘Resources/Price Transparency’ menu on main page
Specific charges search shows no behavioral health grouping, no results with obvious search terms such as ‘therapy,’ ‘family therapy’, ‘group therapy.’ Consumer would have to know the technical medical procedure code. |
| Notification if financial aid, payment plans, and assistance in enrolling for Medicaid or a state program are available | Yes | No | |
| Quality of care indicators if available | No | No | |
| Displaying information in languages other than English to meet the needs of the communities and populations the hospital serves | No | No | |
| Clear communication about location at which the shoppable service is provided if hospital has more than one location, and whether estimate is for an inpatient or outpatient service | Yes/No | No | Search allowed by hospital within system
No clear indication of in- versus outpatient service for psychotherapy at hospitals where this is provided |
Source: 10 Steps to Making Public Standard Charges for Shoppable Services
PRICES
|
Behavioral Health Service |
Price (Uninsured Self-pay) |
| Psychotherapy with patient 30 minutes | “This procedure is not provided by this hospital.” |
| Psychotherapy with patient 45 minutes |
Same as above |
| Psychotherapy with patient 60 minutes |
Same as above |
| Family psychotherapy without patient present 50 minutes |
Same as above |
| Family psychotherapy with patient present 50 minutes |
Same as above |
| Group psychotherapy |
Same as above
|
Note: Though the “shoppable service” search reports these services are not provided at this hospital, these services are listed along with prices in the machine readable and pdf files available on the website.
2022 UnityPoint Health Meriter
https://www.unitypoint.org/madison/default.aspx
COMPLIANCE CHECKLIST
|
CRITERION |
2022 |
2021 |
NOTES |
| Comprehensive machine-readable file |
Yes |
Yes | At https://www.unitypoint.org/madison/patient-charges-and-costs.aspx in machine-readable and pdf formats |
| Consumer-friendly display of standard charges for at least 300 ‘shoppable’ services grouped with charges for ancillary services that are customarily provided by the hospital (see Alternative Checklist) |
Yes shoppable No ancillary |
Yes shoppable No ancillary |
At https://www.unitypoint.org/madison/patient-charges-and-costs.aspx |
| Notification if financial aid, payment plans, and assistance in enrolling for Medicaid or a state program are available |
Yes |
Yes |
At https://www.unitypoint.org/madison/patient-charges-and-costs.aspx and https://www.unitypoint.org/madison/financial-assistance.aspx |
| Quality of care indicators if available |
No |
No |
|
| Displaying information in languages other than English to meet the needs of the communities and populations the hospital serves |
No |
No |
|
| Clear communication about location at which the shoppable service is provided if hospital has more than one location, and whether estimate is for an inpatient or outpatient service |
Yes Location No in- versus outpatient |
Yes Location No in- versus outpatient |
Source for checklist: 10 Steps to Making Public Standard Charges for Shoppable Services
PRICES
|
Behavioral Health Service |
Price (Uninsured Self-pay) |
| Psychotherapy with patient 30 minutes | ”We couldn’t create an estimate with the information you provided. Please call us at [number] for further assistance” |
| Psychotherapy with patient 45 minutes | Same as above |
| Psychotherapy with patient 60 minutes | Same as above |
| Family psychotherapy without patient present 50 minutes | “We didn’t find any services matching your search. Try searching for a different keyword or browsing the categories tab.” |
| Family psychotherapy with patient present 50 minutes | Not listed and/or not provided at main hospital. Price at affiliated hospital in IL (UPH PEORIA METHODIST) shows “total hospital fee” of $519, with 20% discount and “you pay” price of $415 |
| 90853 Group psychotherapy | No listing and/or not provided at main hospital. Prices at affiliated hospitals:
Peoria Full Fee $922 “You pay” $738 Waterloo IA Full fee $1289 “You pay” $1031 Dubuque IA Full fee $1854 “You pay” $1854 Quad Cities “couldn’t create estimate” Cedar Rapids Full fee $1098 “You pay” $878 Sioux City Full fee $3416 “You pay” $2733 |
Note: Though prices are not listed for main hospital in a “shoppable services” search, they are listed in both the machine-readable and pdf as well as searchable CDM at https://www.unitypoint.org/madison/patient-charges-and-costs.aspx. These files are not likely to be understandable to consumers.
Initial search suggests need to provide personally identifying information at https://www.unitypoint.org/madison/online-estimate.aspx
Non-identfiable search located at https://www.unitypoint.org/madison/patient-charges-and-costs.aspx and https://tinyl.io/5XI5
2022 University Hospital
https://www.uwhealth.org/locations/university-hospital-170
COMPLIANCE CHECKLIST
| CRITERION | 2022 |
2021 |
NOTES |
| Comprehensive machine-readable file |
Yes |
Yes |
In spreadsheet format |
| Consumer-friendly display of standard charges for at least 300 ‘shoppable’ services grouped with charges for ancillary services that are customarily provided by the hospital (see Alternative Checklist) |
Yes |
Yes |
No obvious link from main page, requires search with ‘price transparency’ or related terms |
| Notification if financial aid, payment plans, and assistance in enrolling for Medicaid or a state program are available |
Yes |
No |
|
| Quality of care indicators if available |
Yes/No |
No |
Categories and descriptions, no data/comparable measures apparent |
| Displaying information in languages other than English to meet the needs of the communities and populations the hospital serves |
Yes/No |
N |
In Spanish, no other languages apparent |
| Clear communication about location at which the shoppable service is provided if hospital has more than one location, and whether estimate is for an inpatient or outpatient service |
Yes/No |
Y |
Yes for location, no clear indication of in- versus outpatient pricing |
Source for checklist: 10 Steps to Making Public Standard Charges for Shoppable Services
PRICES
|
Behavioral Health Service |
Price (Uninsured Self-pay) |
|
Psychotherapy with patient 30 minutes |
$154* Full fee $237 |
| Psychotherapy with patient 45 minutes |
$239 Full fee $368 |
|
Psychotherapy with patient 60 minutes |
$349 Full fee $537 |
| Family psychotherapy without patient present 50 minutes |
$246 Full fee $379 |
|
Family psychotherapy with patient present 50 minutes |
$238 Full fee $366 |
| Group psychotherapy |
$92 Full fee $142 |
*All prices show “35% discount” from full fee to uninsured self-pay fee.
Discussion
Since the 2021 review, beginning January 1, 2022 the penalties for hospital noncompliance have been increased to $300 per day for hospitals with 30 or fewer beds, up to $5,500 maximum per day, and $10 per bed per day for hospitals with more than 30 beds (which applies to all three of these Madison hospitals), with a minimum total penalty of $109,500 per hospital, and maximum total penalty up to $2,007,500 per hospital. CMS has issued warning letters to more than 300 hospitals, and, if penalized, hospitals may be publicly identified on the CMS website. No monetary penalties have yet been assessed, and it unclear whether any of the Madison hospitals have been warned. Given the results of this review, local hospitals may be at risk of being penalized. The public may submit complaints.
Considering the variability in prices when these are available, shopping for therapy services based at least in part on price may benefit consumers, particularly if there is flexibility on choice of location. Given that quality data for behavioral health services do not appear to be publicly reported at this time for the hospitals reviewed, shopping on price may be a key consideration for consumers. Questions of quality may still need to be done the “old fashioned way”: word of mouth, and asking trusted others where they may have had positive or less satisfactory experiences with clinicians.