Powerful new tools for health care cost containment

By Steve Bassett  ·  Sep 23, 2022

Last in a series. To read the first three installments of this cost-containment series, see Medical inflation is outpacing other costs and services, Samaritan's Provider Relations team works to keep your medical bills low, and I can do this! 3 tips for working with medical providers on your own.

We have another powerful cost-containment tool to share from a surprising source—the federal government.

It’s turning out to be a challenging year to be a hospital CFO. Too many costs and not enough revenue are setting the stage for prices to resume their steep, upward trend in the season ahead. Hospitals are absorbing the highest level of general price inflation in more than 40 years while also granting significant pay increases to nurses due to staffing shortages. In addition, overall inflation, which briefly was higher than health care inflation, is now set to start affecting the health care sector. Given the emerging pressure on hospitals, the information in this series is turning out to be even more timely than originally thought. We want to help you weather the storms of these economic times, which is why we are offering guidance to help you keep your Share costs down. And so, this month, we’re sharing a tool that comes from an unusual source: federal law.

The government can help?

Ronald Reagan famously quipped, “The nine most terrifying words in the English language are, ‘I’m from the government and I’m here to help.’” Many of us would generally agree with Reagan's remark, but we’re now living in a moment where particular government actions actually do help the Samaritan Ministries family redeem health care.

If you go to a mechanic—at least a reputable one—you would expect to get an estimate of the cost of repair before he starts the work. He would tell you the work that he was going to perform and how much it would cost. That way, you could decide if you wanted to pay him to do the work before he started doing anything. Seems like common sense, right?

Illustration of a piggy bank hiding behind a cowboy boot

But the business of health care isn’t known for common sense. Instead, for years, the way it worked was that you would go into the hospital for a procedure, but the cost would all be guesswork. After the procedure, you would wait and wince while the hospital calculated the price and billed you. If you asked for a price beforehand, the hospital would just shrug.

That’s no longer allowed due to several federal actions.

First, under an executive order known as the Hospital Price Transparency rule, all hospitals must publish cash-pay and other prices on their website as of January 1, 2021. Also, under the No Surprises Act, as of January 1, 2022, hospitals must provide patients an estimate of the cost of their procedure upon request and are then required by law to bill a final price within $400 of that original estimate. Now you can find prices ahead of time and make an informed purchasing decision.

How to use the Hospital Price Transparency Rule

You might think, “Now, why didn’t hospitals publish their prices before?” Well, that’s a rather long story for another day. Suffice it to say that compliance has been slow since the rule was implemented. Still, it is steadily improving due to increased federal noncompliance penalties and even states considering laws to add to the penalties.

But won’t it be a lot of work to hunt down the cash pay prices? You may be pleasantly surprised at how easy it can be to now find a consumer-friendly display of a minimum 300 shoppable services on hospital websites as required by the rule. Hospitals are also required to publish machine-readable data files on their websites. As these files are published, data aggregators have begun to develop tools to help consumers compare prices.

It’s not unusual for cash-pay prices to vary by a factor of 10 or more for the same service in the same geographic area, and, as stewards of other members’ Shares, you and your family can make good use of this rule for non-emergency care. Also, be aware that as a cash-pay patient, you can submit complaints if you find hospitals to be noncompliant, which may even help enforce the transparency rule.

How to use the No Surprises Act

Now that you know what the cash-pay price is and feel confident that this will be high-quality care, you can confirm costs in advance with a good-faith estimate. Will it be a complicated, bureaucratic process to get an estimate? Thankfully,

it’s not!

As part of the No Surprises Act, hospitals must post instructions on how to get these estimates on their websites. Many have created online tools where you can enter the procedure that you are considering and get an estimate created on the spot. If the online tool doesn’t list your procedure, the hospital should have instructions on whom to call to get your estimate.

Illustration of a piggy bank being tied up by the feet

If you find that a hospital is giving you trouble with getting an estimate, feel free to reach out to our Provider Relations team. For assertions that any final billed prices were substantially in excess of the good faith estimate, a dispute resolution process is available in which you can respond to hospital non-compliance identifying yourself as a self-pay patient. The good news is that you probably won’t have to do this because hospitals are on notice that they need to abide by these new rules.

Focusing on price and quality

As we discussed in September's article (bit.ly/smi-cost-3), price does not always correlate to the quality of care, but as you consider the best quality care for you and your loved ones, recent government actions that force the exposure of hospital prices can help you discover the best value in the market. Here are some points to remember to help you find high-value care out of recent government actions:

  • Use the estimate tool on your local hospital’s website for an upfront price.
  • Comparison shop among hospitals.
  • Choose the right hospital for you and get a good faith estimate.
  • Reach out to the Samaritan Ministries Provider Relations team if you need help!

This series has highlighted rising health care costs and what we can do about it. We discussed how our Provider Relations team is addressing the challenge. We also offered tips and tools for you to continue to be good stewards of health care sharing dollars.

In coming months, we’ll increase our focus on price and quality. The newsletter will offer further guidance and program improvements that focus on making high-value care easier to find and, thus, keep Shares affordable.

Steve Bassett is director of Samaritan Ministries' Office of Strategic Services.