Eric Borgerding
In all corners of our state, Wisconsin hospitals and health systems continue to provide
a level of care that consistently ranks among the best in the country. Our state’s acute care hospitals – 96% of which are nonprofit – have deep roots in the communities they serve, providing essential
services and filling needs when no one else will or public services fall short.
Not only does Wisconsin rank among the best states in the country to receive hospital care, we’ve also led the nation in helping patients get the pricing information they need. Increasingly, patients feel they should have a better understanding of what they’re paying for their care. We agree, and that’s why Wisconsin hospitals offer a range of solutions to assist patients. We can’t vouch for the same when it comes to pricing transparency by health insurance plans, including those sponsored by businesses and employers.
Hospitals in southeast Wisconsin and throughout the state provide upfront pricing notifications to patients prior to their appointments, online price estimator tools, and financial counselors to help patients navigate a system made frustratingly complex by insurance companies and other middlemen; not hospitals. Indeed, it’s largely insurance company policies like copays, deductibles, prior authorizations, and myriad other hoops and hurdles that increase patients’ frustration and out-of-pocket costs, but which hospitals are forced to implement.
That’s why it was so frustrating to read a
recent article that claims Wisconsin’s hospitals and health systems fall short in their commitment to provide clear, transparent pricing information to our patients. The fact of the matter is nothing could be further from the truth.
Wisconsin hospitals have track record on pricing transparency
Critics of hospitals suggest we play a game of keep-away with this cost-of-care data and fabricate an imaginary incentive for hospitals to do so. Their arguments are simply detached from reality. Wisconsin hospitals are pillars within our communities, in which our doctors and nurses live, work, and take care of their neighbors. It is ridiculous and insulting to Wisconsin’s health care workers – who show up to work every day to save lives – to suggest that they’re instead running a scheme to bamboozle their neighbors.
There are a number of regulations on the books requiring patients to have access to the data they need to make informed decisions about their care, including the cost of services by hospitals, as well as similar data from insurance companies and self-funded employer plans. Enforced and overseen by the federal Centers for Medicare and Medicaid Services (CMS), Wisconsin notably has not had a single hospital receive a citation for noncompliance with these regulations.
Still, hostile special interest groups have appointed themselves the arbiters of hospital price transparency compliance, inventing their own standards and creating unfounded reports that continue to be proven
intentionally misleading and false. And while these biased attacks on hospitals continue, the lack of attention to federal price transparency regulations on insurance companies and self-funded employer plans is increasingly conspicuous. Indeed, data regarding their compliance is strikingly absent.
State a pioneer in making data available to consumers
Beyond Wisconsin hospitals’ strong record as determined by federal regulators, our hospitals have long been a leader in making health care pricing data available, pioneering tools and tactics to more easily put this important data in the hands of those that matter most – our patients. Since 2005, our state’s hospitals have voluntarily released price data to consumers on a per-facility and per-procedure basis – long before other states were even considering such innovations. In 2023, WHA also launched Price Finder, a free, easy-to-use online tool where consumers can find links to every Wisconsin hospital’s negotiated rate file, along with either a list of shoppable services or a price estimator tool.
All this is in addition to the tools available from local hospitals across the state. Aurora Healthcare, for example, testified to the state legislature that they provided nearly 350,000 price estimates to patients without the patients requesting it. That was just in the first nine months of 2023, and doesn’t even count the patients who proactively contacted one of Aurora’s many financial advocates looking for assistance to determine their cost of care.
If you have any questions about the price of services at your local hospital, I encourage you to
do what Lisa Adams did – pick up the phone to call your local hospital’s team of financial counselors. If you haven’t tried this in the last decade, you might just be amazed.
This column originally appeared in the Milwaukee Journal Sentinel on May 10. You can access the article here.