Folks in the Sonoma Valley and across the country likely will have an easier time finding and comparing prices for hospital services under a new federal mandate that went into effect Jan. 1.
The new rule requires hospitals to publish online price lists for all the medical services they provide. The hospitals already had to release prices publicly under the Affordable Care Act, but under the new rule, the prices must be published online in a format that can be downloaded to computers.
Sonoma Valley Hospital has listed the charges for all 3,000 of its services on its website. The list can be found at svh.com/patients-visitors/billing-insurance-financial-assistance/cdm-drg-search/.
For purposes of comparison, the charges for the most common outpatient procedures at California hospitals can be found on a central location, the website of California’s Office of Statewide Health Planning and Development, at oshpd.ca.gov/data-and-reports/cost-transparency/hospital-chargemasters/2018-chargemasters/.
The federal mandate was issued in mid-December and went into effect Jan. 1. California hospitals were a bit ahead of the curve, because “for more than a decade, California hospitals under state law have been required to publicly file their prices annually,” said Jan Emerson-Shea, a spokeswoman for the California Hospital Association.
The list of prices is known as a “chargemaster” - a master list detailing the official rate charged by a hospital for individual procedures, services and goods.
Reactions to the new requirement have been mixed.
“It’s important to understand that when a consumer looks at this document, it’s not going to be particularly useful to what they are seeking. This list of prices is not what an individual person would pay,” Emerson-Shea said. “It’s a master list of prices a hospital would use to negotiate.”
Medicare and Medi-Cal do not pay based on the list; both entities pay a flat rate, Emerson-Shea said. The amount a person with insurance pays depends on their insurance coverage, not the chargemaster, she said.
“If you have an HMO, you typically have a flat out-of-pocket payment,” Emerson-Shea said, referring to health maintenance organizations such as Kaiser that have their own network of doctors, hospitals and other healthcare providers who have agreed to accept payment at a certain level for any services they provide.
“Someone who has a PPO might be responsible for 20 percent of the copayment,” Emerson-Shea said, referring to preferred provider organizations, which offer the freedom to receive care from any provider in or out of network.
Sonoma Valley Hospital’s charge for an emergency room visit on the moderate severity level is $1,326, according to the Office of Statewide Health Planning and Development website. The charge for such a visit at Queen of the Valley Hospital, about 16 miles away, is $2,518. Santa Rosa Memorial, about 20 miles away, listed its charge as $2,315 and Marin General’s charge is $2,310.
For an MRI of the brain without contrast followed by contrast, Sonoma Valley’s charge is $9,486, Queen of the Valley’s is $7,452, Santa Rosa Memorial’s is $2,338. Marin General did not list a charge.
For an abdominal CT scan with contrast, Sonoma Valley’s charge is $6,844, Queen of the Valley’s is $2,318, Santa Rosa Memorial’s is $1,875 and Marin General’s is $5,700.
The charge for a bilateral mammogram screening is $761 at Sonoma Valley, $273 at Queen of the Valley, $257 at Santa Rosa Memorial. The charge for Marin General was not listed.