Does the United States Need a National Hospital Billing Data Set?

Patient's experience in hospitals andhospital billing can vary significantly, even if two hospitals are just a few miles away from each other. In essence, the American patient has no idea what their financial experience will be when they step into the hospital setting – they’re rolling the dice. 

But a dedicated organization is trying to provide some transparency around the hospital billing and financial experience. The Lown Institute has launched a two-year long endeavor to look into hospital revenue cycle practices around some of the most controversial hospital behaviors, including sending patients to collections, denying care, and filing lawsuits against patients with unpaid bills [1]. 

It is a logical extension of recent efforts around price transparency and pushback on “surprise billing” practices. Starting in 2021, hospitals were mandated to post chargemaster prices, payer negotiated prices, and discounted cash prices for the public. (Compliance has been spotty, with only a third of hospitals meeting requirements as of 2023 [2].)  

This could be a very fruitful project since hospital pricing can vary significantly. Recent studies have illuminated just how much prices vary across the country [3]. Urban hospitals average prices 14% lower than rural, teaching hospitals have prices 3% higher than nonteaching, and nonprofit and for-profit hospitals price 9% and 39% higher than government-owned hospitals, respectively. Hospital practices can also directly impact patient lives. Hospital billing decisions can leave patients with damaged credit scores and increase financial hardship, and this can vary by condition. “Financial toxicity”, for example, has been found to be worse for cancer patients [4].

I can see this being both challenging and beneficial for hospitals. If the patient experience at least has an informal standardization, hospital billing and hospital coding strategy goals are simplified. Best practices and benchmarking would be much easier if hospital leadership had insights into their peers’ decisions. This also means hospital leadership will have more direction when establishing billing standards, creating debt collection practices, and working with outside vendors and revenue cycle management services. 

The report for this project won't be issued until 2025, but I’m looking forward to it. It will cover 2,500 hospitals and I think marks a new future of hospital billing standards for providers across the nation.