Wisconsin patients can check hospital fees

The Wisconsin Hospital Assn. is developing a Web site to provide consumers with information about how much hospitals statewide charge for various services. Users would be able to compare the charges for a variety of care ranging from mammograms to knee replacements.

At the same time, a Wisconsin hospital system, ProHealth Care Inc., has launched a consumer hotline to give patients information about the retail charges for services at its two hospitals in Waukesha County.

Wisconsin hospitals have been under a legislative mandate for nearly a decade to provide claims and billing data to the state, said Dana Richardson, vice president of quality initiatives for the Wisconsin Hospital Assn. About a year ago, WHA took over data collection operations for the state.

The information has been available for some time, though Richardson said it was primarily available in raw data sets that wouldn't make sense to most consumers. So the WHA decided to launch a free Web site that would make the data user-friendly for consumers.

George Quinn, senior vice president of the WHA, said the goal is to have the Web site running by the end of the year.

"As the consumer-driven model becomes more prevalent, and I think it will, consumers will need to have this kind of information available to make decisions in their health care," he said.

But some question whether the information could scare patients away from seeking costly types of care. They also wonder whether the data will be meaningful to users, because the materials don't include information about all the possible charges that can stem from an episode of hospital care, or details about managed care discounts.

Susan L. Turney, MD, chief executive officer and executive vice president of the Wisconsin Medical Society, said information on hospital charges may not be adequate in helping patients make informed choices.

"It's good to have that information, but you have to tie in the other side, which is quality. I'm not sure medical care should be decided on cost alone," she said.

Dr. Turney said hospital care can include a wide array of charges ranging from room rates and surgical fees to anesthesia and prescription drugs. She questioned whether patients would be able to anticipate all relevant charges and get complete information.

"Someone may have the perception that this is the best deal for them, but they're really not understanding that there are other charges surrounding that episode of care," she said.

A wealth of information

The WHA hopes to address that concern by providing billing information by diagnosis related groups, meaning a procedure like an appendectomy would be represented with a total charge for the typical whole service, Richardson said.

However, patients who have additional needs beyond standard care could incur other charges that would not be reflected in the information. Charges from physicians and some subcontracted services would also be excluded because they are billed separately. Also, Richardson said the information wouldn't be specific enough to let consumers know what discounts they might get through their managed care plans.

"It's a great starting block -- a way for consumers to get at least some information and then to dialogue with their insurer," she said.

Quinn said he doesn't believe that the information will prompt many patients to skimp on necessary care. "I think while there might be a small danger in that, more likely is that consumers will still work with their physicians, and they should work with their physicians."

Quinn said that in addition to providing data on retail charges, some information will be available about the aggregate average percentage of the charges paid by Medicaid and Medicare or commercial payers.

Meanwhile, ProHealth Care has already launched its phone service, and it has seen demand for it increase in its nascent stages.

In three months of tests before the hotline officially debuted, about 80 callers per month dialed in for the information, said Nan Nelson, vice president of managed care and decision support services for ProHealth. In September, the first month it was running, the hotline received about 130 calls.

Nelson said the hotline is staffed by nurses 24 hours a day. They can access a database to provide information on retail charges for approximately 140 services.

"It will help build trust and it offers an opportunity to assist customers, and inform and educate them about health care, which is a very complicated service offering," said Nelson.

Rick Wade, spokesman for the American Hospital Assn., said some states and government entities have been collecting similar data for years, though it is not widespread.

However, Wade said he had never before heard of a hospital system sharing the information.

"There's been an enormous reluctance do to that, largely due to competitive pressure. But I think we're getting past that," he said. "You're beginning to see the public's demand to get more information of all aspects of their medical care."