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Price transparency? A new Medicare rule requires hospitals to post their standard charges online

TWIN FALLS — If you’re looking for information about how much a hospital can charge you for different medical procedures or lab work, you can now find it online.

Under a new rule that aims for more transparency in health care costs, Medicare is requiring hospitals to post their standard prices online and make electronic medical records more readily available to patients, The Associated Press reported in late December. The program is also starting a comprehensive review of how it will pay for costly new forms of immunotherapy to battle cancer.

The rule affects hospitals nationwide, including here in south-central Idaho, and it’s not just for big hospitals. In addition to St. Luke’s Magic Valley Medical Center, the requirement affects small, critical access hospitals like the St. Luke’s Jerome and Wood River medical centers, North Canyon Medical Center in Gooding, Cassia Regional Hospital in Burley and Minidoka Memorial Hospital in Rupert.

South-central Idaho’s hospitals have met the new requirement on time, but say while the step toward pricing transparency in a good one, the information may be complex for patients to navigate. Plus, patients are generally more interested in their own insurance coverage and how much they’ll end up paying of pocket.

“One of the most meaningless numbers to a patient who has insurance is what a hospital charge is,” said Matt Morishita, senior director of revenue integrity for the St. Luke’s Health System.

What’s more valuable, Morishita said, is what patients can expect to pay out of pocket. “That’s really the lens we’re going to look at this as.”

St. Luke’s list of standard charges — which is posted on the health system’s website on the cost estimator page — is essentially everything St. Luke’s can bill a patient for, he said. That includes supplies, procedures performed, lab services and in-patient room rates.

A standard charge, though, “doesn’t necessarily represent the price you’ll actually pay for your service,” he said.

St. Luke’s is still encouraging patients to contact their insurance company for coverage information and to use its cost estimator tool online.

Seema Verma, head of the Centers for Medicare and Medicaid Services, said the new requirement for online prices reflects the Trump administration’s ongoing efforts to encourage patients to become better-educated decision makers in their own care, the Associated Press reported.

The Medicare rule is the first step in creating pricing transparency, Morishita said, adding it wants to work to prevent any billing surprises for patients. Fewer than 25 percent of hospitals provide cost estimates based on insurance, he added. “St. Luke’s is in the infancy phases of that.”

Figuring out exactly what the U.S. Centers for Medicare & Medicaid Services wanted in the standard price list was a process. “As with most CMS guidelines, they’re very gray,” Morishita said. “They’re not descriptive with what they’re looking for.”

CMS put out multiple “frequently asked questions” summaries to clarify the rule and outline expectations for what should be in each hospital’s file, Morishita said.

St. Luke’s has known about the CMS rule since it came out this summer, he said, and was finalized in November.

It wasn’t a ton of work complying with the requirement, Morishita said, estimating it took maybe 40 hours in total. The biggest process was “researching what CMS really wanted to have in the files to be in compliance.”

CMS requires the file to be a “machine-readable format,” Morishita said. St. Luke’s used a CSV (comma-separated values) file. As far as the formatting, “it’s not going to be very pretty.”

At Minidoka Memorial Hospital in Rupert, chief financial officer Jason Gibbons said he’s hesitant to say the list of standard charges will be “really useful” for a patient. Patients still have to navigate their own insurance coverage. “Every patient really has to know what their coverage is like.”

But “CMS is trying to empower the patient and we totally understand that,” Gibbons said. “I hope it doesn’t create more confusion.”

Minidoka Memorial Hospital patients are welcome to call the hospital to get a cost estimate, he said.

The hospital posted its standard charges on its website Dec. 28. It wasn’t a challenge to compile the list, Gibbons said, because the chargemaster file already existed. But hospital officials did organize the information by department — such as radiology and laboratory — to try to make it easier for patients to navigate.

The biggest problem: The hospital doesn’t host its own website. A CSV file tends to be considered malicious on a hosted website and the website provider was reluctant to host that file, Gibbons said. “As a small facility, that really has been our biggest challenge.”

The hospital temporarily converted the file to a PDF document, Gibbons said, adding they’ll work through a process to create something like a Google Drive account to allow for a machine-readable file format.

Another challenge: As a critical access hospital, CMS doesn’t require Minidoka Memorial Hospital to use CPT codes for billing, Gibbons said. That means patients trying to make price comparisons with other hospitals wouldn’t necessarily be able to do that without a CPT code, he said. “We’re hoping it doesn’t create more confusion than it’s worth.”

Officials at Cassia Regional Hospital in Burley — part of Salt Lake City-based Intermountain Healthcare — declined to comment on the new Medicare rule, but Intermountain issued a statement.

The statement says there are “better options” for patients to get information, including Intermountain and SelectHealth’s online cost estimator tools. It also says medical record information has been online for more than a decade via the Intermountain Health Hub app.

At North Canyon Medical Center, the new Medicare rule is “a step in the right direction making all health care providers accountable for what their pricing is,” CEO Tim Powers said.

But a machine-readable format required by CMS “doesn’t mean the general public can understand it,” Powers said. North Canyon’s chief financial officer cleaned up the formatting the best she could “so when the consumer opened it, they’re not overwhelmed by looking at the data.”

Before the Medicare rule was handed down, North Canyon had already been talking about improving pricing transparency — a topic that has been discussed for more than a year.

“The consumer out there is getting to be pretty knowledgeable and is doing a much better job of shopping,” Powers said, and the cost for patients is a huge component of their decision about where to seek care. “Quality is obviously a huge element of it, but in this day and age, economics is playing a huge role in patients making the determination of where they want to get their health care at.”

St. Luke’s has a robust cost estimator tool on its website, Powers said, North Canyon is trying to replicate.

North Canyon has the cost of some of its most common services — including x-rays, lab work, imaging tests and family medicine visits — pulled out on its website to try to make it as early as possible for patients to find, hospital spokeswoman Shellie Amundson said. Information has been available since last August and the new CMS list of standard charges was posted Dec. 31.

North Canyon receives a lot of phone calls from patients wanting to know exactly what they owe, Amundson said. Hospitals can’t post what every insurance company will cover, she said, since there are so many plans and it would be impossible to do.

Patients have to understand what their own insurance coverage is, Powers said. “It’s not an easy process for the consumer to make.”

North Canyon will provide as much detail as possible, Powers said, but it can only be boiled down so far.

“Health care continues to be a very complex set of pricing variables out there.”


DREW NASH, TIMES-NEWS PHOTO ILLUSTRATION 

Snake River Canyon seen Monday, Nov. 26, west of Twin Falls.


Govt-and-politics
Why does this charity golf event hosted by Idaho’s governor cost more than it gives out?

BOISE — Gov. Butch Otter ran down the list of his accomplishments, after more than a decade in office, in a November farewell speech to the Boise Metro Chamber of Commerce.

On his list: the annual Governor’s Cup tournament — a multi-day golf and sporting affair that alternates annually between resorts in Coeur d’Alene and Sun Valley — which raises money for Idaho college and trade-school scholarships. The event, created in 1974 by then-Gov. Cecil Andrus as a “small golf tournament,” is hosted by the governor and first lady. It is attended by Idaho’s political and business movers and shakers.

The event raised $1.3 million in 2018, Otter told the chamber to applause. What he didn’t say was how much of that money will go toward scholarships — less than half, if history is an indication.

Almost every year of the past decade, the nonprofit that runs the tournament has spent at least twice as much money on throwing the annual event than it has awarded in financial aid.

Students received $2.1 million in scholarship awards in the time that the Idaho Governor’s Cup nonprofit spent $6.1 million on the annual event. That doesn’t include the nonprofit’s other operating expenses.

That has raised concerns about the purpose of the event. But some nonprofit experts and the Governor’s Cup chairman argue that the scholarships would not exist without the annual fundraiser.

What does the Cup achieve?

The Statesman was not granted interviews with Gov. Butch Otter, first lady Lori Otter or Gov.-elect Brad Little for this story. First lady Lori Otter has been on the board of directors since at least 2007. Their media representatives said their schedules were too tight during the holidays and in the days leading up to the administration changeover this week to accommodate even a short interview.

“Miss Lori and I are profoundly proud and humbled to have played a small part in the ongoing success this program has achieved,” Gov. Otter said in a statement provided by the nonprofit’s executive director. “In our 12 years hosting the event, the First Lady and I have watched more than 300 Idaho students begin their journey at an Idaho school. That keeps our kids at home, while supporting Idaho post-secondary higher education. With the recent expansion of the program to include not only community colleges and universities, but also career technical scholarship students, the program is poised once again to grow.”

Hundreds of people attend the Governor’s Cup every year, the nonprofit says. The event last year drew sponsorships from well-known Idaho companies such as Albertsons, Blue Cross of Idaho, Idaho Power, Micron, Simplot and St. Luke’s.

The tournament raised $1.3 million in 2017, but it cost more than $827,000 for resort rental, food and drink, entertainment and other expenses, according to federal tax filings. The nonprofit gave out $399,000 in financial aid to students that year.

While the cost of the fundraising event has grown, so has the amount of money the Governor’s Cup gives out in scholarships. Since 2010, its financial aid to Idaho students has grown an average of 23 percent a year. (The event cost grew an average of 9 percent a year in that time.)

A former federal regulator says the event’s cost calls into question the event’s primary purpose. Is it to raise funds for students by attracting donors with three days of fun at an exclusive getaway? Or is it to give lobbyists and businesspeople an opportunity to curry favor with government officials, with the benefit of supporting a scholarship program?

“It sure sounds like this is an opportunity for lobbyists to do what lobbyists do outside the eyes of reporters or the general public,” said Marcus Owens, a partner at Loeb & Loeb LLP in Washington, D.C., and former director of the Internal Revenue Service’s division for tax-exempt organizations.

But the Governor’s Cup board chairman says the event is philanthropic and its expense is necessary. Idaho has only two resorts with all the amenities people expect at the Governor’s Cup, he said, and they’re pricey.

“All those costs are important, because that’s what makes the event what it is,” said the board chairman, eastern Idaho businessman Doug Sayer. “Without those costs, I just don’t think we would have an event at all.”

Sayer, who didn’t know when asked how much the event has cost in recent years, took issue with the Statesman asking questions.

“Before someone wants to take a shot at being critical of our event, I think you should attend and see the philanthropy,” he said. “It’s about changing those kids’ lives.”

The Statesman and any other observers would have to buy tickets, he said.

“I encourage them to sign up and to join the event and participate ... and that includes paying your own way,” he said. “That’s what puts the kids in school.”

Hundreds of students sent to college

The event has helped more than 250 students pay for their schooling in the Otter administration alone, Sayer said. Many of them are high-achieving but disadvantaged students. Some are the first in their families to attend college. They’re staying in Idaho for school and told the board they dream of careers in medicine, engineering and other industries where Idaho is short of home-grown professionals.

The Governor’s Cup offers Idaho students between $3,000 and $12,000 toward their college education. (The $3,000 scholarship is renewable for up to four years for academic students, or three years for career-technical students.)

It also created a special scholarship in 2017, named for Andrus, for a student planning to become an educator.

Here’s what some of the 2018 scholars said in thank-you notes to the nonprofit:

  • “I have lived without my family for about three years. It has been really hard to be here on my own, having to worry about things a teenager my age shouldn’t even have to think about.”
  • “My parents were not able to attend college or even finish high school due to not having sufficient funds.”
  • “Since losing my father to a heart attack, money has been tight, and it’s so important for me to have this financial support.”
  • “My parents’ income made me ineligible for a Pell Grant, but my family’s ongoing extensive medical expenses make it practically impossible for my parents to help with my education. ... This scholarship is an answer to my prayers!”
  • “I honestly didn’t know how I was going to pay for college ...”
  • “I have had many medical expenses since being diagnosed with [a rare autoimmune disease] and since we had to travel to [the East Coast] twice a year for treatment, my parents were not able to save as much as they wanted to help me with college.”

There’s more need than ever for scholarships, as colleges raise tuition and fees and students amass debt to pay for school.

The Governor’s Cup had more than 1,000 applicants in 2018, competing for 36 scholarships. That’s up from just four years ago, when the program had more than 500 applicants competing for 23 scholarships.

Money flows at the Cup

The Governor’s Cup ticket prices range from $125 for an evening ticket to $35,000 for a top-tier sponsor like Simplot to send 16 people for the full event.

The tickets pay for activities such as golf and shooting competitions, cooking classes, bicycle rides, wine tastings, spa time and horseback rides. The event also raises money through auctions, such as a car donated by Sayer in 2017.

The tickets are to help fund the scholarships. Still, no more than 38 percent of the gross receipts from the event has ever been distributed to students the following year, according to the past decade’s federal tax filings. On average, less than 25 percent of the gross is converted into scholarships.

“From an IRS perspective, the issue would be whether the organization is operating primarily to make scholarships or whether it’s operating primarily as a social club that has fundraising [for] scholarships on the side,” Owens said.

Fundraising experts recommend that nonprofits keep event costs low so they can retain as much of the charitable donations as possible. There’s no hard and fast rule, but fundraising guides recommend spending less than you make from an event.

One reason nonprofits sometimes offer high-cost events is “friend-raising.” This is viewed as more of an investment — converting participants into year-round, loyal donors. Sayer told the Statesman that there have been donations outside of the big Governor’s Cup event, but the organization’s tax filings don’t show any significant year-round giving.

Other events keep more money

The Statesman compared the fund’s tax records with those of other Idaho nonprofits that host fundraising events for a specific purpose. Three of those events were golf tournaments, which tend to be expensive but high-yield fundraisers, according to one nonprofit expert.

The golf events cost 24 cents to 58 cents to throw per $1 of charitable donations collected.

The annual Killebrew-Thompson Memorial golf tournament takes place in Sun Valley, over multiple days, and attracts high-profile attendees including politicians. It costs about 50 cents for every dollar of charitable contributions it keeps, according to tax records.

In contrast, the Governor’s Cup spends more than $1 to raise $1, based on its past decade of tax filings. At its most, it spent $2.53 for every dollar of donations made in 2013, the filings show.

Sayer said the Governor’s Cup is a one-of-a-kind event and shouldn’t be compared to other fundraisers.

The Killebrew-Thompson tournament does not offer as many activities as the Governor’s Cup. It does have non-golf events such as shooting, a concert and an auction gala.

The nonprofit that runs that tournament says it leverages the funds raised from the event to get matching donations. The money supports cancer research, including grants to the St. Luke’s Mountain States Tumor Institute.

The Killebrew-Thompson Memorial event in 2016 cost about $288,000 and reported about $572,000 in charitable donations. It awarded $860,000 that year in grants, according to federal tax records.

‘The inevitable happens’

Critics of the Governor’s Cup, such as Wayne Hoffman of the Idaho Freedom Foundation, have raised concerns in the past that the Cup is a networking event, where a monied few can hobnob with the governor and other dignitaries.

“The premise is, you’ve got to go kiss the ring, you’ve got to attend, you’ve got to sponsor,” Hoffman told the Statesman.

Owens, the former IRS official, wondered who is paying for government officials to attend — a question Hoffman also has raised.

Even if officials are paying their own way, the structure of the event can invite regulatory scrutiny because the nonprofit might be “providing the format — the opportunity — for the lobbying communication,” Owens said.

“You’re off at a resort with legislators and lobbyists, and the inevitable happens,” he said. “The organization doesn’t have to do anything more than put them all in the same room for a long weekend. The real possibility of pay-for-play sort of activity here is significant.”

Sayer argued that the organization is a laudable nonprofit whose all-volunteer board spends many hours reviewing scholarship applications and working to raise money for the scholarships.

“If people don’t want to go to the event, but they want to be involved with our organization and help put kids in college and trade schools, they can contribute year-round,” he said.

One hundred percent of those donations would go to scholarships, he said.


If you do one thing

If you do one thing: A community dance will feature music by the Shadows Band from 7 to 10 p.m. at the Snake River Elks Lodge, 412 E. 200 S., Jerome. Admission is $5.


ASSOCIATED PRESS FILE PHOTO  

Idaho Gov. C.L. “Butch” Otter speaks at the State Capitol building in Boise.


National
AP
Trump says 'not much headway' in talks as shutdown drags on

WASHINGTON — White House officials and congressional aides emerged from talks aimed at ending a partial government shutdown over President Donald Trump's demands for border wall funding without a breakthrough Saturday, though they planned to return to the table today.

Trump tweeted: "Not much headway made today." Democrats agreed there was little movement, saying the White House did not budge on the demand for $5.6 billion and would not consider re-opening the government.

The White House said funding was not discussed in-depth, but the administration was clear they needed funding for a wall and that they wanted to resolve the shutdown all at once.

Accusations flew after the more than two-hour session led by Vice President Mike Pence. Acting chief of staff Mick Mulvaney, in an interview with CNN's "State of the Union," accused Democrats of being there to "stall." Democrats familiar with the meeting said the White House position was "untenable."

A White House official also said the meeting included a briefing on border security by Homeland Security Secretary Kirstjen Nielsen. Democrats sought written details from the Department of Homeland Security on their budget needs, which the White House said it would provide.

With talks stalled, House Speaker Nancy Pelosi announced that House Democrats plan to start approving individual bills to reopen shuttered departments starting with Treasury to ensure Americans receive their tax refunds.

"While President Trump threatens to keep the government shut down for 'years', Democrats are taking immediate further action to re-open government, so that we can meet the needs of the American people, protect our borders and respect our workers," Pelosi said.

Mulvaney argued the administration was willing to deal in an interview with NBC's "Meet the Press," set to air today. He said Trump was willing to forgo concrete wall for steel or other materials.

"If he has to give up a concrete wall, replace it with a steel fence in order to do that so that Democrats can say, 'See? He's not building a wall anymore,' that should help us move in the right direction," Mulvaney said.

The president has already suggested his definition of the wall is flexible referring to slats and other "border things." But Democrats have made clear they see a wall as immoral and ineffective and prefer other types of border security funded at already agreed upon levels.

Trump campaigned on the promise that Mexico would pay for the wall. Mexico refused. He's now demanding the money from Congress. Trump, who did not attend the discussions, spent the morning tweeting about border security.

Showing little empathy for the hundreds of thousands of federal workers furloughed or working without pay, Trump declared — without citing evidence — that most are Democrats. He also asserted: "I want to stop the Shutdown as soon as we are in agreement on Strong Border Security! I am in the White House ready to go, where are the Dems?"

One Democrat, Maryland Sen. Chris Van Hollen, said in his party's weekly radio address that the shutdown "is part of a larger pattern of a president who puts his personal whims and his effort to score political points before the needs of the American people. ... He is pointing fingers at everyone but himself."

Trump and Democratic leaders met for roughly two hours Friday, but gave differing accounts of the session. Democrats reported little progress; Trump framed the weekend talks as a key step forward.

As the shutdown drags on, some Republicans are growing increasingly nervous. Some GOP senators up for re-election in 2020, including Cory Gardner of Colorado and Susan Collins of Maine, voiced discomfort with the shutdown in recent days. Collins tried to broker deals to end past stalemates.

Sen. Thom Tillis of North Carolina penned an op-ed for The Hill, arguing that Congress should end the shutdown and make a deal on border security and immigration reforms.

In calling on Trump to reopen government while negotiations on border security continue, Democrats emphasized families unable to pay bills due to absent paychecks. But Trump repeatedly said he will not budge without money for the wall.

Trump asserted on Friday that he could declare a national emergency to build the wall without congressional approval, but would first try a "negotiated process." Trump previously described the situation at the border as a "national emergency" before he sent active-duty troops. Critics described that as a pre-election stunt.

Trump said the federal workers who are furloughed or working without pay would want him to "keep going" and fight for border security. Asked how people would manage without a financial safety net, he said: "The safety net is going to be having a strong border because we're going to be safe."