NC Senate repeats demand for data on payments to hospitals

05/30/2014 6:01 PM

02/15/2015 11:24 AM

The state Senate is making one thing absolutely clear in its budget: The Department of Health and Human Services must post detailed information on what hospitals charge and get paid for their most common procedures.

Among the reforms passed in 2013 was a law mandating that hospitals and ambulatory surgical centers post the prices they charge for their 20 most common surgeries, 20 most common imaging procedures, and the 100 most common hospital admissions.

The providers would also have to disclose what they are paid for each procedure by Medicare, Medicaid, each of their five largest private insurers, and an uninsured patient.

Charges for the same procedure can vary greatly from hospital to hospital. And payments vary by who is paying. For a $1,000 charge, Medicaid may pay $300, Medicare may pay $330, and private insurers may pay anywhere from $400 to $750.

Sen. Bob Rucho said he was worried that DHHS might publish an average of the payments, which would be useless to patients and consumers. So the Senate budget would order DHHS to publish the prices and payments from each payer to the hospitals and surgical centers.

“We were seeing a reluctance to share the data as much as we asked them to,” said Rucho, a Matthews Republican. “We want to send a message: This is how we want it, and we want it done soon.”

Last year, the General Assembly passed laws aimed at making hospitals more patient-friendly and hospital bills more understandable.

The laws came after a series of stories in The News & Observer and The Charlotte Observer that explored how the growing market power of hospitals has driven up prices. The stories revealed soaring profits at large nonprofit hospitals, huge executive salaries, minimal spending on charity care and efforts by hospitals to sue uninsured patients delinquent on their bills or to turn over the accounts to collection agencies.

The Senate budget also would require DHHS to publish detailed Medicaid payments made to individual providers, such as doctors, therapists or dentists. The federal government recently released similar data on the $585 billion Medicare program, which made up about one-sixth of federal spending in 2013.

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