Advocacy group says pricing at Kansas City hospitals isn't clear for patients

If you need medical care provided by a hospital in Missouri and check the website for how much it will cost, you might have trouble finding that information despite a federal law requiring hospitals to tell people what they charge for different services.

Only one in five of the state’s hospitals has posted enough data to comply with a 2021 law, according to a recent report from Patient Rights Advocate, a Washington, D.C.-based consumer group.

“Nearly everyone has a story of themselves or their family member being overcharged by the healthcare system,” said Cynthia Fisher, the founder and chairman of Patient Rights Advocate. “And we need actual prices to have remedy and recourse to prove that we've been overcharged.”

Under current regulations, hospitals must publicly post a significant amount of data including prices for every service they offer and every drug they provide. That includes actual prices negotiated with an insurer and the amounts that a cash-paying patient would be charged.

This information must come in two ways: A “consumer-friendly display” or price tool with standard charges for at least 300 “shoppable” services and a comprehensive machine-readable file that includes charges for all hospital items and services.

According to Patient Rights Advocate, only 10 out of 46 hospitals the organization reviewed in Missouri were fully compliant. Nationally, the report suggested as many as 65.5% of about 2,000 hospitals were not complying fully.

While the report cited several Kansas City-area hospitals for non-compliance in certain areas, most of those hospitals, as well as the Missouri Hospital Association, say they rely instead on the more limited sampling conducted by the Centers for Medicare and Medicaid Services, or CMS. The government agency released a report in January 2023 that said 70% of 600 hospitals are complying with the website assessment criteria, with machine-readable files and a price estimate tool.

Children’s Mercy Hospital

According to the PRA, the Standard Charges File on the Children’s Mercy Adele Hall website failed to adequately identify specific plans for all commercial payers when reviewed on Sept. 3, 2023.

A hospital spokesperson refuted the claim, saying their files were updated and posted that same month with charges for the 2024 fiscal year.

“Our price transparency files posted on our public website are compliant with the CMS hospital price transparency rule and do include our standard charges, self-pay pricing, and contracted reimbursement rates for managed care plans,” said Marlene Bentley, spokesperson for Children’s Mercy Kansas City.

The standard charges file now is dated as of Sept. 5, 2023.

North Kansas City Hospital

North Kansas City Hospital's standard charges file was formatted incorrectly as a JSON file when reviewed Sept. 10, 2023, according to the report.

Hospital spokeswoman Amy Schemnauer said the hospital is currently in compliance and will continue to dedicate “extensive resources” to align with CMS policy.

“We will continue our regular and ongoing efforts in the area of price transparency,” Schemnauer said. “Patients seeking price estimates for their care can contact us directly or use our various self-service options available on the NKCH public website.”

The file link posted on the NKHC website does not open to an Excel sheet but rather a URL, which lists the effective date as July 1, 2023.

Saint Luke's Hospital Kansas City

Like Children’s Mercy, the PRA report says the Standard Charges File on the Saint Luke’s Hospital Kansas City website failed to adequately identify specific plans for all commercial payers when reviewed on Sept. 3, 2023.

A spokesperson for the hospital said they are are compliant by CMS standards.

The Saint Luke’s website says all charges have been updated as of December 2023. The file appears to contain additional data from when PRA reviewed it.

HCA Midwest

Several HCA Midwest locations were deemed non-compliant by PRA.  

The files for Research Medical Center, Centerpoint Medical Center and Lee’s Summit Medical Center all failed to provide an adequate amount of de-identified minimum, maximum and negotiated rates, and did not adequately identify specific plans for all commercial payers, according to the report.

Belton Medical Center’s files did not provide an adequate amount of negotiated rates.

"Our hospitals implemented the federal requirements in January 2021," said Christine Hamele, HCA Midwest spokeswoman, adding, they have "posted contracted rates with third party payers using one of the machine-readable file formats listed in the regulations to provide the five types of "standard charges."

All locations have updated their files since PRA reviewed them, according to the HCA Midwest website.

Celia Llopis-Jepsen

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Kansas News Service

Defining necessary transparency

The 2021 rule was an attempt to clarify often uncertain hospital prices that may vary widely by location or even within the same hospital. Only after losing a lawsuit that challenged the rule did hospitals begin to fall in line.

The non-profit organization Healthcare Financial Management Association called PRA’s report “irresponsible” and “incorrect,” calling into question the methodology used and PRA’s interpretation of federal rules.

Dave Dillon, a spokesman for the Missouri Hospital Association, said there are certain hospitals that aren’t meeting the criteria but an estimate of 22% compliance was far too low.

“The evolving version of transparency is that we have to list negotiated rates for all of the components of hospital care, rather than just in having the providers report,” Dillon said. “Nonetheless, hospitals realize that this is the real deal and are working to comply with additional transparency.”

He noted a study from Turquoise Health — a group that collects data and grades hospitals on transparency — suggesting at least 91% of 5,763 hospitals across the country had posted a machine-readable file by the end of 2023.

Fisher, the PRA founder, agreed in principle that many of these hospitals do provide these files, but questioned whether they are properly accessible and include information to the letter of the law. In Kansas City, that was the reason hospitals were listed as non-compliant.

Even when hospitals make data accessible, a 2023 analysis by KFF found hospitals are inconsistent with where price transparency information is on the website and how the files may be organized. Analysis authors said even an expert might have a tough time parsing through all this information.

Fisher said if the files were formatted and organized correctly, consumers could much more easily compare the cost of certain treatments under different insurance plans and weigh them against the cost of a cash payment.

With that kind of accessibility and the tech world’s involvement, she said, it’s possible to imagine searching for hospital services the same way people search for flights at Kayak.com.

“We would be able to even see Uber type of platforms,” she said, where consumers might say, “‘OK, give me the price of an MRI after 6 p.m. within a 45-minute radius of where I live,’ and see who would compete at what price and what availability."

Starting last year, the Biden Administration increased possible fines for failing to comply. They range from $300 to $5,500 per day and a maximum of $2 million in a year.

But so far, of the approximately 5,000 hospitals in the U.S., the Centers for Medicare & Medicaid Services has taken action against just six, with eight more under review. None are in Missouri.

Dillon cautioned against levying significant fines and penalties, which he said could be counterproductive to hospitals that are unknowingly missing certain bits of information. He said hospitals are working in the same systems as everyone else and the process isn’t always straightforward.

In most cases where a hospital has received some sort of warning, they’ve responded to the issue, Dillon said.

But Fisher suggested this leniency might be why some states are considering legislation of their own that would further crack down on the issue of hospital price transparency. In Missouri, House Bill 1837 would expand upon current state hospital price transparency law by allowing patients to effectively sue for the difference between the expected bill and the actual cost.

State Rep. Aaron McMullen, an Independence Republican, filed the bill and wrote a recent opinion piece in the Kansas City Star.

“I don't know about you, but I've had that sense of impending dread when you find your hospital bill and you have no idea what it's gonna be,” McMullen told KCUR. “After running the op-ed, I’ve received an outstanding outreach from constituents all across the political spectrum writing that, yes, this is something we do need. It affects everyone unfortunately.”