Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources.
The Trust Project
ROCHESTER — A new Minnesota law that aims to boost patients' access to medical providers' price transparency data is now in effect.
The new law builds upon federal requirements from the Centers for Medicare & Medicaid Services — all hospitals in the United States must provide both a machine-readable data file that contains all the hospital's standard charges as well as a "consumer-friendly display of standard charges for . at least 300 shoppable services."
But when these federal requirements took effect in 2021, CMS "had required hospitals to disclose prices, but they hadn't standardized a lot of elements," said Krutika Amin, associate director for the Program on the ACA at the Kaiser Family Foundation.
In early 2023, Amin and her colleagues published an analysis of hospital price transparency data that showed a lack of consistency and missing information among the data provided.
"They finalized a rule just a couple months ago requiring hospitals to follow a specific format," Amin said of CMS, "but there's still challenges with the hospital price transparency data for several reasons."
Many of those challenges have to do with a lack of standardization for how charges are labeled in the data files and how some charges are calculated.
"Some of the labeling might be very technical," Amin said. "One hospital might be disclosing a percentage, but not really saying what it is a percentage of, whereas another hospital has a per-day rate, and so it gets really complicated really quickly."
To create some consistent practices for how Minnesota's hospitals display their price transparency data, Rep. Steve Elkins, DFL-Bloomington, introduced a bill in the Minnesota Legislature's 2023 session.
"The information right now that Minnesota consumers should be seeing," Elkins said, "should be much, much higher quality."
Here's how the new law came about and how to use the available information.
"I wasn't seeing anywhere near the kind of uptake of that recommended practice that I thought would really measurably improve the quality of the data that was actually accessible to consumers," Elkins said. "And so I wrote this bill to say, OK, with this voluntary stuff, I want to make this mandatory for hospitals in Minnesota, knowing that if I could standardize the format . the information that Turquoise would be publishing related to Minnesota hospitals would be guaranteed to be consistent."
Minnesota's new price transparency law also requires hospitals to post their links to the CSV file and consumer-facing cost estimator tool on a Price Transparency webpage. The hospital's website must have a link to the Price Transparency page at the bottom of its homepage.
Before the state law took effect, hospitals had to post this data online, but there wasn't a particular, consistent place where they had to be hosted, said Joe Schindler, vice president of finance policy at the Minnesota Hospital Association. Back in 2021, he said, when the New York Times reported that many hospitals were not, at that time, complying with the price transparency rules, MHA reviewed its member hospitals to see if they were complying.
"We were able to find all the files," Schindler said. "It wasn't necessarily always easy to find them, but we did find them."
Now, every hospital in Minnesota should have their Price Transparency data webpage linked at the bottom of their website's homepage. That requirement took effect Jan. 1, 2024.
"We have worked with our members throughout the year to provide resources to ensure our members were aware of the changes and offered any assistance needed to help them comply with the new mandate," Schindler said. "That said, we do not have a monitoring function to check all of their websites."
In 2025, dental practices, freestanding surgical centers and other medical providers will also need to comply with this law. Right now, Elkins said, there is not a federal requirement for these providers to publish their standard charges.
"I think some of them will actually want to voluntarily start publishing their data because, in many cases, those specialty practices — especially in areas like radiology — are the low-cost providers, and they would want consumers to know that," Elkins said.
A collection of links at the bottom of regional health systems' websites that feature the required "Price Transparency" link, as seen on a mobile device. Hospital websites, clockwise from top left, are Mayo Clinic, Winona Health, Gundersen Health System and Olmsted Medical Center.
A hospital's standard charges can be found on its Price Transparency webpage. It will contain links to the hospital's CSV file and online cost estimator tool.
Bigger hospital networks will have multiple CSV files available. For example, Mayo Clinic has one cost estimator tool available, but it has separate text data files for its Minnesota, Arizona and Florida campuses. CSV files for Mayo Clinic Health System hospitals are hosted on the MCHS website.
Through the hospital's cost estimator tool, patients can search the service they're looking for by keyword or by the Current Procedural Terminology (CPT) code. Then, they can enter their insurance information, or opt to get an estimate without insurance, to get a price for that service.
Patients could also use a price comparison platform such as Turquoise Health, which Amin and her colleagues partnered with for their price transparency data study. Patients can input the name or CPT code for their service and their ZIP code to compare prices at hospitals within a certain distance.
In addition, area health systems have additional resources to help patients navigate procedure and service costs. In a statement, Audrey Ceplecha, director of revenue cycle for Winona Health, said price estimators work "only if you know the right information to put in."
"That’s why we have a patient resource room where our staff helps patients understand their insurance coverage — or lack of coverage," Ceplecha continued. "We have a process to screen patients who are uninsured so we can help them obtain medical coverage either through Medicaid or the exchange. We also have HPE (Hospital Presumptive Eligibility) certified staff, who can gain Minnesota Medicaid coverage immediately if the patient qualifies. And, we have a financial assistance program."
