Posting Chargemasters On-Line: Less than Meets the Eye

Michigan is just the latest state to consider legislation requiring hospitals to post their chargemasters on-line.  Mich. Sen. Bill 147.  These proposals have been popping up since 2013, when Time magazine devoted a full issue to the evils of hospital pricing and identified the chargemaster as the main villain.

The argument for posting them is simple: if consumers could just look up the price of a procedure, they could shop around for the best deal.  Price competition would prevail, and prices would go down.

Simple, right?  Well, maybe not.  One problem is size.  A chargemaster can easily contain over 100,000 entries.  And it can get updated on an almost-daily basis, as services are added, dropped, or changed and as codes and prices change.  And it’s not written for laymen.  It has a language all its own—a language mostly in initials rather than words: UB04, CPT, HCPCS, and SIM, to name a few.  In fact, it calls itself a CDM rather than a chargemaster.   But even when the language is in words, they aren’t necessarily self-explanatory.  What’s an INJECTION IM/SUBCUTANEOUS or a CATHETER ATHERECTOMY?  (CDMs love capital letters.)

Even if you get past all that and have a handle on potential hospital charges, what about all the other providers?  Say you’re having a hip replaced.  You’ll get bills for x-rays and imaging services, for anesthesiology, for pathology and lab tests, for office visits before and after surgery, possibly for physical therapy and rehabilitation, and maybe for a walker and a cane.  And, oh yes, your surgeon may also want to get paid.  In the traditional hospital model, most or all of these services and devices are provided by individuals and entities that are not part of the hospital.  They have their own charges and, presumably, their own charge lists.

So when your hospital posts its chargemaster on-line, you may find there’s less to it than meets the eye.

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