Price transparency is a challenge that has gained significant attention from patients, health plans, employers, policymakers, and the media. This focus has gone beyond fair pricing to the uninsured to encompass the overall level and variation of hospital charges, including underlying costs and negotiated payments. The proliferation of high-deductible plans, ongoing Medicare price data releases and the continued attention of the media invite pricing inquiries.
IHA's CFO Forum, charged with examining various aspects of price transparency, continues to provide guidance and input for advocacy strategies as well as tools and resources as hospitals seek to provide relevant and meaningful price information.
IHA developed Price Transparency Principles as a tool to focus and shape the discussion as the industry moves toward greater transparency. 191 or 92% of IHA member hospitals have pledged to adopt the IHA Price Transparency Principles.
Tools & Resources
IHA developed Provider Health Plan Education Information as a tool to help hospitals assist insured patients with additional price information by directing them to their health plan's cost estimator tools and other health literacy information.
Average Charges for Illinois Hospitals
The Illinois Department of Public Health (IDPH) collects inpatient and outpatient charge information from hospitals. Hospital-specific average charges for 28 inpatient and 20 outpatient major diagnosis are available on the Hospital Report Card and Consumer Guide to Health Care
website. Median charge information is located under the Services tab.
Since the 1980s, Illinois law has required hospitals to make available to prospective patients information on the normal charge incurred for any procedure or operation the prospective patient is considering, as well as post current charges for 18 specific services (20 ILCS 2215/4-4).
The Fair Patient Billing Act requires hospitals to notify patients about the availability of financial assistance and to comply with specific requirements regarding billing and collections. Regulations require specific format for financial assistance application forms and policies for presumptive eligibility. The Hospital Uninsured Patient Discount Act requires hospitals to provide free and discounted care to eligible uninsured patients.
The Affordable Care Act requires hospitals to make public the hospital's standard charges for items and services provided by the hospital [Affordable Care Act, Section 2718(e) of the Public Health Service Act]. Final regulations would allow hospitals to either make public a list of their charges (their charge master or another form of their choice) or their policy for allowing the public to view a list of those charges.
- IHA's handouts (password required) for hospitals allowing public view of charges and FAQs
IRS Section 501(r)
The IRS issued a final rule implementing new Section 501(r) that required Section 501(c)(3) hospitals to charge patients eligible for financial assistance no more than the amounts generally billed to patients with health insurance, as well as specific requirements pertaining to financial assistance policies and collection and conducting community health needs assessments.