What does a knee replacement cost? Florida health website now includes hospital prices for common procedures
One uncertainty from a hospital stay may be less uncertain now.
The Florida agency overseeing hospitals has beefed up a consumer-focused healthcare website to now include costs of procedures at hospitals and ambulatory surgery centers. The costs are based on negotiated rates that insurers pay to hospitals.
Consumers can look up 44 frequently queried non-emergency procedures and see what the average cost is at a specific hospital, including what the average cost is at all hospitals in the community, the state and nationally.
With a procedure such as hip or knee replacement, there’s an explanation of what’s involved, questions to ask, how to prepare and what’s typically involved for recovery.
The state Agency for Health Care Administration launched pricing.floridahealthfinder.gov in 2017 to give consumers an idea what insurance plans pay for procedures.
The upgrade adds average cost for procedures at specific hospitals so consumers can make comparisons. The information includes how the averages are based on insurance claims.
“I think it’s a good initial step in a long and complicated process,” Rick Wyles, chief financial officer for the NCH Healthcare System, said. “It’s a good general guide.”
Consumers need to keep in mind the average price listed for a procedure at a hospital isn’t definitive but is useful for comparisons, he said.
Consumers need to contact their insurance plan for what their out-of-pocket expense is going to be, Wyles said.
At the start of his administration, Gov. Ron DeSantis directed the state agency to expedite the roll out the hospital pricing data.
“Health care is the only industry where a consumer purchases something without knowing the price or value, and that needs to change,” DeSantis said in a statement.
The website says the cost figures are based on 67 million claims from a set of insurers and their negotiated rates paid from Jan. 1, 2016 through Dec. 31, 2017.
The average price in Lee County for knee replacement is $46,000, and the website lists the average costs at the four hospitals run by Lee Health.
Change the search location to “Naples” and the average cost in Collier County is about $35,000, along prices listed for the two campuses of the NCH Healthcare System and Physicians Regional at Pine Ridge.
The state average for knee replacement surgery is $37,000 and it is $36,000 nationally.
The Florida Hospital Association, which has had its own pricing website called Mission to Care at missiontocare.org, initially said it was surprised the state health agency launched the pricing component without letting hospitals first verify the data.
There has since been a meeting between the state and FHA leaders to discuss concerns, Bruce Rueben, president of the hospital association, said.
The data for the FHA website comes directly from hospitals as opposed to insurance claims data, he said.
There isn’t anything wrong with the state agency’s website, it’s just a different set of data, Rueben said.
The health care transparency movement is still in its early stages and a lot of entities are getting on board, including many states to offer hospital information about quality and cost, he said.
“We want to give useful information, and as we are going through it, we are learning what is useful and not useful,” Rueben said.
Every year, the price of the most basic of treatment services within Southwest Florida's largest hospital system — using an inpatient bed — goes up 5 percent. Oscar Santiago Torres and Frank Gluck, Fort Myers News-Press
The publicly operated Lee Health in Lee County supports the state agency's efforts to improve price transparency for consumers, spokeswoman Mary Briggs said in a statement.
"Still, like the Florida Hospital Association, we have serious concerns about the validity of the data underpinning the website and its practical use for patients," she said.
When asked why average costs at Lee Health are higher than at the NCH Healthcare System for a handful of common procedures, Briggs said the state's website used negotiated rates with commercial payers but the rates were not confirmed by hospitals and the validity is unknown.
"We wish we could shed more light on the published information, but we don't know the source of the data or the adjustments the state made in calculating the results," Briggs said.
Some prices for common procedures on the state website are lower than what's listed with the hospital association's website, she said.
Lee Health has found that patients are more interested in knowing and understanding their out-of-pocket expenses rather than average prices.
"Lee Health is committed to helping our patients understand and navigate complex health care costs, which is why we encourage any patient with questions about their medical bill to contact our dedicated financial services team for individualized information," she said.
In July, the U.S. Centers for Medicare & Medicaid Services announced price transparency requirements aimed to increase competition among hospitals by making them publicize gross charges and payer-specific negotiated charges for all items and services provided in a hospital.
CMS administrator Seema Verma said in a statement in July that consumers will be able to shop for health care just as they do for everything else, and the policy will include civil penalties of $300 a day for hospitals not in compliance.
A Jan. 1, 2020 effective date was given initially, but Verma indicated last week the requirement will be delayed.
She said CMS had received 1,400 comments on the hospital pricing requirement and the agency will summarize them and respond in an upcoming rule, according to Healthcare Finance News.
Examples of negotiated rates that insurers paid
Hip replacement surgery
National average - $36,244
Florida average - $36,869
Lee County average $45,620
Cape Coral Hospital - $40,042
Gulf Coast Medical Center - $40,864
HealthPark Medical Center - $45,481
Lee Memorial Hospital - $45,481
Collier County average- $34,766
NCH Downtown Baker Hospital - $32,858
NCH North Naples - $32,858
Physicians Regional, Pine Ridge - $35,837
Coronary angioplasty with drug-eluting stent
National average - $38,719
Florida average - $38,736
Lee County average - $40,361
Gulf Coast Medical Center - $40,403
HealthPark Medical Center - $42,067
Lee Memorial Hospital - $ 42,067
Collier County average -$36,483
NCH Baker Hospital - $30,417
NCH North Naples - $30,417
Physicians Regional, Pine Ridge - $42,548
Back pain - lumbar fusion
National average - $69,333
Florida average - $73,960
Lee County average - $84,795
Gulf Coast Medical Center - $82,313
Cape Coral Hospital - $86,483
Collier County average -$80,757
Physicians Regional, Pine Ridge - $80,757
Child birth - vaginal delivery
National average - $12,772
Florida average - $15,124
Lee County average - $16,209
HealthPark Medical Center - $16,126
Lee Memorial Hospital - $16,126
Cape Coral Hospital - $16,293
Collier County average - $14,182
NCH North Naples - $14,182