Along with social isolation came the rapid introduction of remote access to everything from work to workouts.

This article was published on Tuesday, January 17, 2023 in Kaiser Health News.

By Christina Saint Louis

MALMO, Minn. — Eight women, all 73 or older, paced the fellowship hall at Malmo Evangelical Free Church to a rendition of Daniel O'Donnell's "Rivers of Babylon" as they warmed up for an hourlong fitness class.

The women, who live near or on the eastern shore of Mille Lacs Lake, had a variety of reasons for showing up despite fresh snow and slippery roads. One came to reduce the effects of osteoporosis; another, to maintain mobility after a stroke.

Most brought hand and ankle weights, which they would use in a later portion of the program focused on preventing falls, known as Stay Active and Independent for Life, or SAIL. The class meets twice a week in Malmo, a township of about 300 residents. It is run by Juniper, a statewide network of providers of health promotion classes.

A few years ago, older adults who were interested in taking an evidence-based class like SAIL — meaning a class proved by research to promote health — had only one option: attend in person, if one was offered nearby.

But then the COVID-19 pandemic and physical distancing happened. Along with social isolation came the rapid introduction of remote access to everything from work to workouts.

After widespread lockdowns began in March 2020, agencies serving seniors across the U.S. reworked health classes to include virtual options. Isolation has long since ended, but virtual classes remain. For older adults in rural communities who have difficulty getting to exercise facilities, those virtual classes offer opportunities for supervised physical activity that were rare before the pandemic.

And advocates say online classes are here to stay.

"Virtually the whole field knows that offering in-person and remote programming — a full range of programming — is a great way to reach more older adults, to increase access and equity," said Jennifer Tripken, associate director of the Center of Healthy Aging at the National Council on Aging. "This is where we need to move together."

Since April 2020, the National Council on Aging has organized monthly conference calls for service providers to discuss how to improve virtual programs or begin offering them.

"We found that remote programming, particularly for rural areas, expanded the reach of programs, offering opportunities for those who have traditionally not participated in in-person programs to now have the ability to tune in, to leverage technology to participate and receive the benefits," Tripken said.

In 2022, at least 1,547 seniors participated in an online fitness program through Juniper, part of a Minnesota Area Agency on Aging initiative. More than half were from rural areas.

Because of grant funding, participants pay little or nothing.

Juniper's virtual classes have become a regular activity both for people who live far from class locations and others who because of medical needs can't attend. Carmen Nomann, 73, frequented in-person exercise classes near her home in Rochester before the pandemic. After suffering a rare allergic reaction to a COVID vaccine, she's had to forgo boosters and limit in-person socializing.

Virtual classes have been "really a great lifeline for keeping me in condition and having interaction," she said.

Since 2020, Nomann has participated in online tai chi and SAIL, at one point logging on four days a week.

"Now, we would never go away from our online classes," said Julie Roles, Juniper's vice president of communications. "We've learned from so many people, particularly rural people, that that allows them to participate on a regular basis — and they don't have to drive 50 miles to get to a class."

When seniors drive a long way to attend a class with people from outside their communities, "it's harder to build that sense of ‘I'm supported right here at home,'" she said.

Roles said both virtual and in-person exercise programs address social isolation, which older adults in rural areas are prone to.

Dr. Yvonne Hanley has been teaching an online SAIL class for Juniper since 2021 from her home near Fergus Falls. She had recently retired from dentistry and was looking for a way to help people build strength and maintain their health.

At first, Hanley was skeptical that students in her class would bond, but over time, they did. "I say ‘Good morning' to each person as they check in," she said. "And then during class, I try to make it fun."

AgeOptions, an Illinois agency serving seniors, has seen similar benefits since introducing virtual fitness programs. Officials at the agency said last year that their operations "may have changed forever" in favor of a hybrid model of virtual and in-person classes.

That model allows AgeOptions to maintain exercise programs through Illinois' brutal winters. Organizers previously limited winter activities to keep older adults from traveling in snow and ice, but now AgeOptions leans on remote classes instead.

"If the pandemic didn't happen, and we didn't pivot these programs to virtual, we wouldn't be able to do that," said Kathryn Zahm, a manager at AgeOptions. "We would just potentially spend months limiting our programming or limiting the types of programming that we offered. So now we can still continue to offer fall-prevention programs throughout the year because we can offer it in a safe way."

But the new approach has challenges.

AgeOptions has identified increasing access to technology as a funding priority for the next few years, to ensure seniors can sign on.

The agency found that for many "folks in rural communities it was a challenge not only for them to have the device but to have the bandwidth to be able to do video conference calls," Zahm said.

Tripken said providers and participants need guidance and support to facilitate access to virtual classes.

"For older adults in particular, that includes ensuring those with vision loss, those with hearing loss, those with low English proficiency" can participate in virtual classes, she said.

Some programs have created accommodations to ease the technology barrier.

Participants in Bingocize — a fall-prevention program licensed by Western Kentucky University that combines exercise and health education with bingo — can use a printed copy of the game card mailed to them by AgeOptions if they lack the proficiency to play on the game's app. Either way, they're required to participate on video.

The mail option emerged after Bingocize fielded requests from many senior service organizations trying to figure out how to offer it remotely, said Jason Crandall, the creator and international director of Bingocize.

Crandall designed Bingocize as a face-to-face program and later added the online application to use during in-person classes. Then COVID hit.

"All of a sudden, all of these Area Agencies on Aging are scrambling, and they were scrambling trying to figure out, ‘How do we do these evidence-based programs remotely?'" Crandall said.

He said Bingocize was one of the few programs at the time that could quickly pivot to strictly remote programming, though it had never done so before.

"From when the pandemic began to now, we've come light-years on how that is done," he said, "and everybody's getting more comfortable with it."

Christina Saint Louis: christinas@kff.org, @cnsaintlouis

The U.S. health system benefits from potentially more than $5 billion in free volunteer labor annually.

This article was published on Tuesday, January 10, 2023 in Kaiser Health News.

By Lauren Sausser, Kaiser Health News

MOUNT PLEASANT, S.C. — Most of the 30 volunteers who work at the 130-bed, for-profit East Cooper Medical Center spend their days assisting surgical patients — the scope of their duties extending far beyond those of candy stripers, baby cuddlers, and gift shop clerks.

In fact, one-third of the volunteers at the Tenet Healthcare-owned hospital are retired nurses who check people in for surgery or escort patients to a preoperative room, said Jan Ledbetter, president of the hospital's nonprofit Volunteer Services Organization. Others relay important information from hospital staffers to expectant families. "They're kept extremely busy," Ledbetter said. "We need to have four of those volunteers a day."

At hospitals across the U.S., volunteers play an integral role. So much so that when volunteers were barred from East Cooper at the beginning of the COVID-19 pandemic, staff nurses assumed the volunteers' duties in the surgical waiting room. Like paid employees, hospital volunteers typically face mandatory vaccine requirements, background checks, and patient privacy training. And their duties often entail working in regular shifts.

At HCA Healthcare, the world's largest for-profit hospital system, volunteers include aspiring medical providers who work in patient rooms, in labs, and in wound care units, according to the company's magazine.

Over centuries, leaning on volunteers in medicine has become so embedded in hospital culture that studies show they yield meaningful cost savings and can improve patient satisfaction — seemingly a win-win for hospital systems and the public.

Except, there's a catch.

The U.S. health system benefits from potentially more than $5 billion in free volunteer labor annually, a KHN analysis of data from the Bureau of Labor Statistics and the Independent Sector found. Yet some labor experts argue that using hospital volunteers, particularly at for-profit institutions, provides an opportunity for facilities to run afoul of federal rules, create exploitative arrangements, and deprive employees of paid work amid a larger fight for fair wages.

The federal government instructs that any person performing a task of "consequential economic benefit" for a for-profit entity is entitled to wages and overtime pay. That means profit-generating businesses, like banks and grocery stores, must pay for labor. A Chick-fil-A franchise in North Carolina was recently found guilty of violating minimum wage laws after paying people in meal vouchers instead of wages to direct traffic, according to a Department of Labor citation.

Still, volunteer labor at for-profit hospitals is commonplace and unchecked.

"The rules are pretty clear, and yet it happens all the time," said Marcia McCormick, a lawyer who co-directs the Wefel Center for Employment Law at Saint Louis University. "It's a confusing state of affairs."

In a statement, HCA spokesperson Harlow Sumerford said coordinators oversee hospital volunteers to ensure they are participating in appropriate activities, such as greeting and assisting visitors. Tenet Health spokesperson Valerie Burrow did not respond to a question about how the company ensures that its volunteer activities comply with federal labor laws.

Ben Teicher, a spokesperson for the American Hospital Association, whose members include more than 6,000 nonprofit, for-profit, and government hospitals, did not respond to a question about whether the organization offers guidance to hospitals regarding the legal uses of volunteers.

Meanwhile, the pandemic made the importance of hospital volunteers more apparent. In March 2020, volunteer programs nationwide were largely disbanded, and the volunteers' roles were filled by staff members — or left unfilled — when hospitals closed their doors to everyone except employees, patients, and a few visitors. Volunteers were welcomed back once vaccines became widely available, but many didn't return.

"We've lost so many volunteers," said Ledbetter, who runs the volunteer group at East Cooper Medical Center. "They found something else to do."

On South Carolina's Hilton Head Island, Vicki Gorbett, president of the island's hospital auxiliary, estimated 60% of the group's volunteers who left during the pandemic haven't returned. Much larger hospital systems, some of which boast hundreds or thousands of volunteers, have been affected, too.

"We're building back from the absolute bottom," said Kelly Hedges, who manages volunteers at the Medical University of South Carolina.

Hedges was furloughed for the better part of six months when hospital volunteers were sent home in March 2020. She estimates there are about 600 volunteers at MUSC's hospital campus in Charleston now, down from 700 before the pandemic.

"During a labor crisis, this is a department you want in operation," she said.

While hospital volunteer programs reboot across the country, labor experts say using volunteers may expose some medical facilities to liability.

The Fair Labor Standards Act prohibits "employees" — defined broadly as people an employer "requires or allows" to work — from volunteering their time to for-profit private employers. The same law also requires these employees to be paid no less than the federal minimum wage.

These regulations make it "very, very difficult" for a volunteer to donate time to a for-profit hospital, explained Jenna Bedsole, an employment attorney in Birmingham, Alabama.

The right to be paid isn't waivable, McCormick said, meaning that even those volunteers who don't consider themselves employed may be entitled to compensation. However, the U.S. Department of Labor is "stretched pretty thin" and doesn't enforce the rules that apply to for-profit companies, except in extreme circumstances, she said.

She cited a court ruling in 2017 that found people who volunteered at consignment events for Rhea Lana — a for-profit company that organizes the resale of children's clothing — were employees who should be paid.

But in most cases, McCormick said, it is difficult to determine the outcome of enforcement actions against for-profit companies.

"The Department of Labor sends a letter to the putative employer warning them that it thinks the FLSA is being violated," she said, "and it may not take any other action. And it only issues news releases for big cases."

Companies are more likely to be targeted for the inappropriate use of unpaid interns, she said.

But this isn't to say that, in some cases, individuals can't donate their time in a for-profit setting. In a for-profit nursing home, the federal government has said, people may volunteer without pay if they're attending "to the comfort of nursing home residents in a manner not otherwise provided by the facility." That might include reading to a resident, for example.

One-off charitable opportunities are also possible. A choir group could host a concert in a hospital lobby without violating the law, or a community organization could serve hospital staffers an appreciation lunch.

Beyond that, for-profit "hospitals potentially expose themselves to risk of civil liability," Bedsole said, which could add up in terms of back pay due to employees, fines, and legal fees. If hospital volunteers provide essential services, there is a danger they could be held liable, she said.

Nonprofit hospitals must follow federal labor laws, too.

At the small, nonprofit Baptist Memorial Hospital-Leake in Carthage, Mississippi, the coordinator of volunteers, Michelle McCann, can't use a volunteer in any role that matches an employee's job description. She said she's also prohibited from asking a hospital employee who is off the clock to volunteer their time for a job similar to their own.

"We'd have to pay them for the hours," said McCann, national president of the Society of Healthcare Volunteer Leaders.

Nonprofit hospitals are required to provide a benefit to their communities, such as offering charity care, in exchange for their special tax status. But when it comes to making money, the differences between for-profit and nonprofit hospitals are often negligible to the casual observer, said Femida Handy, a professor of social policy at the University of Pennsylvania.

"When you go to the hospital, do you ask for the tax status?" she asked.

Sam Fankuchen, CEO of Golden, a company that develops software used to organize volunteer labor, said the pandemic hastened a change in public opinion. "Just because an organization is nonprofit, it doesn't necessarily mean they're 100% dedicated to the greater good," he said. "Some nonprofits are better run than others."

Most volunteers are simply trying to figure out how and where they can help in the best possible way, he said.

"The consideration about the tax structure is secondary," said Fankuchen, whose software is used by hospitals and other businesses. "The big picture is that hospitals exist to deliver care. I think it's reasonable that they have volunteer programs."

Jay Johnson, support services manager at Trident Medical Center in North Charleston, South Carolina, coordinates roughly 50 volunteers who contribute an estimated 133,000 hours annually to the for-profit hospital, which is owned by HCA Healthcare.

Trident's volunteers are widely beloved by the staff, he said.

"We actually had a ceremony for them when they came back" when restrictions loosened, Johnson said. Beyond that, volunteers benefit from premium parking spaces and free lunches "to really make sure they're appreciated," he said.

Trident volunteers are required to be vaccinated and undergo a background check. Then, they are assigned to the areas that best match their interests.

Breast cancer survivor Pat LoPresti for example, volunteers in Trident's Breast Care Center. Volunteering provides a sense of purpose and an opportunity to socialize, said LoPresti, a retiree who met her husband, another volunteer, while volunteering at the hospital.

"I started volunteering there because they could use me," LoPresti said. "It's such a privilege to help people in a time when they need it."

Lauren Sausser: lsausser@kff.org, @laurenmsausser

Private equity investors have rolled up orthopedic practices in at least 12 states.

This story was published on Friday, January 6, 2023 in Kaiser Health News.

By Harris Meyer

Dr. Paul Jeffords and his colleagues at Atlanta-based Resurgens Orthopaedics were worried about their ability to survive financially, even though their independent orthopedic practice was the largest in Georgia, with nearly 100 physicians.

They nervously watched other physician practices sell out entirely to large hospital systems and health insurers. They refused to consider doing that. "It was an arms race," Jeffords said, "and we knew we had to do something different if we wanted to remain independent and strong and offer good quality of care."

So, in December 2021, Resurgens sold a 60% share in United Musculoskeletal Partners, their own management company, to Welsh, Carson, Anderson & Stowe, a large New York-based private equity firm known as Welsh Carson. Although details of the sale were not disclosed, physician-shareholders in deals like this typically each receive a multimillion-dollar cash payout, plus the potential for subsequent big payouts each time the practice is sold to another investor in future years.

Orthopedic surgeons, long seen as fiercely independent, are rapidly catching up with other specialist physicians, such as dermatologists and ophthalmologists, in selling control of their practices to private equity investment firms. They hope to grab a bigger chunk of the surging market in outpatient surgery and maintain their position as one of the highest-paid specialties in medicine — $633,620 was the average compensation for orthopedists in 2021. For older doctors, the upfront cash payout and the potential second payout when the business is flipped offers the promise of a posh retirement.

Proponents say private equity investment has the potential to reduce total spending on musculoskeletal care and improve quality by helping physicians move more procedures to cheaper outpatient surgery centers, which have less overhead. It also could help the doctors shift to value-based payment models, in which they charge fixed amounts for whole episodes of care, such as total joint replacements and spine surgeries — receiving bonuses or penalties from insurers based on cost and quality performance.

But critics warn that profit-hungry private equity ownership alternatively could result in higher prices for patients and insurers, more unnecessary surgery, and less access to care for patients on Medicaid or those who are uninsured or underinsured. A recent study found that in the two years after a sale, PE-owned practices in three other medical specialties had average charges per claim that were 20% higher than at places not owned by private equity.

Critics also worry that PE investors will put pressure on doctors to see more patients and use more non-physician providers in ways that could lead to poorer care, as KHN has reported about gastroenterology and other specialties.

"Private equity has no interest in reducing the cost of medicine," said Dr. Louis Levitt, chief medical officer of MedVanta, a Maryland orthopedic management company whose physician-owners have rejected partnering with private equity. "Their goal is to increase profitability in three to five years and sell to the next group that comes along. They can only do it by making the doctors work longer and reduce service delivery."

There are now at least 15 PE-backed management companies — called platforms — that own orthopedic practices across the country, said Gary Herschman, a New York lawyer who advises physicians in these deals. The first orthopedic deals were done in 2017, and dozens of sales have occurred since then, with the pace expected to quicken. In 2022 alone, at least 15 orthopedic practices were sold to PE-owned management companies.

Dana Jacoby, CEO of the Vector Medical Group, a strategic consultancy for physician groups, said several orthopedic platforms built by private equity investors already are on the market for resale to other investors, though she wouldn’t say which ones. The government does not require public reporting of these deals unless they exceed $101 million, a threshold that is adjusted over time.

Private equity investors have rolled up orthopedic practices in at least 12 states, with concentrations in Georgia, Texas, Florida, and Colorado.

Besides United Musculoskeletal Partners, other sizable PE-owned orthopedic platforms include Phoenix-based HOPCo, backed by Audax Group, Linden Capital Partners, and Frazier Healthcare Partners, with 305 physicians in seven states; Alpharetta, Georgia-based U.S. Orthopaedic Partners, backed by FFL Partners and Thurston Group, with 110 physicians in two states; and Fort Lauderdale, Florida-based Orthopedic Care Partners, backed by Varsity Healthcare Partners, with 120 physicians in four states.

Private equity funds, with a reported $1.8 trillion to invest in health care, are attracted to the size of the orthopedic care market. Annual patient spending is nearly $50 billion alone for treating back pain. The soaring demand of aging Americans for joint replacements, the high rates insurers pay for musculoskeletal procedures — such as nearly $50,000 for a knee replacement — and the lucrative array of orthopedic service lines and ancillary businesses, including ambulatory surgery centers, physical therapy, diagnostic imaging, pain management, and sports medicine, make this a tantalizing line of business.

The standard playbook of private equity firms is to pull profits of 20% out of their physician groups each year, then reap up to a 350% return on their cash investment when they sell the platform, say experts involved in these deals.

Orthopedic surgeons "are very excited about getting a $5 million to $7 million check," said Dr. Jack Bert, former chair of the practice management committee of the American Academy of Orthopedic Surgeons. "But some I’ve talked to say the suits come in and tell the doctors, ‘You’re not working hard enough, you’ve got to increase production by 20%.’ That can be a big problem."

Through their sale to Welsh Carson, the Resurgens orthopedists in Atlanta got a capital partner and executive expertise to help them expand by acquiring other orthopedic practices in Georgia and other markets. Soon after the deal, United Musculoskeletal Partners acquired large orthopedic practices in Dallas and Denver, and brought in a second private equity firm as an additional investor. Several other acquisitions are imminent, said Sean Traynor, a general partner at Welsh Carson.

The investment capital and the company’s growing size in major markets will sharpen the doctors’ ability to negotiate richer contracts with insurers, get better deals on equipment and supplies, build more outpatient surgery centers, and improve quality of care for patients.

The physicians, Traynor said, retain full responsibility for clinical governance, and that is protected by a permanent contract provision binding on all future owners.

"Other physicians ask what’s changed [since the sale], and I say nothing, which is great," said Dr. Irfan Ansari, one of the Resurgens orthopedists.

But some large employers, whose self-funded health plans pay for orthopedic care for their workers, view the trend toward private equity ownership warily. They fear the new owners will milk the current fee-for-service system, which financially rewards doctors for providing more — and more expensive — surgical procedures, rather than promoting less costly but effective services such as physical therapy for lower back pain.

"The worry we have is we’re not seeing private equity fulfilling the promise of value-based care," said Alan Gilbert, vice president for policy at the Purchaser Business Group on Health, which represents nearly 40 large private and public employers. "We’re seeing the same short-term financial goals you see with other private equity investments, including pressure to perform non-indicated procedures."

At least two PE-backed orthopedic groups, however, are working with insurers on cost-saving value-based care programs. U.S. Orthopaedic Partners and HOPCo tout their partnerships with insurers, boasting that they’ve built systems to deliver entire episodes of care at lower costs under fixed-payment models.

Jennifer Allen, chief financial officer at Blue Cross & Blue Shield of Mississippi, said her health plan has saved nearly 40% by collaborating with Mississippi Sports Medicine, now owned by U.S. Orthopaedic Partners, on bundled payments for hip, knee, and shoulder replacement procedures as well as several spine procedures. But Allen said the program was launched in 2016 before private equity investors bought that orthopedic group.

"We had established the protocols, the benefits, the bundle, and everything before that," she said. "I didn’t see anything that the private equity platform brought to the table."

Dr. David Jacofsky, HOPCo’s chairman, said private equity owners should be steering their orthopedic groups toward value-based care, but so far he’s not seeing that happening much. "Private equity has lofty goals of wanting to build these things, but the time frame it takes is much longer than private equity wants to stay in these deals," he said. Instead, he added, most are trying to grow bigger and demand higher payments from insurers, and "that’s not good for anyone."

Still, MedVanta’s Levitt isn’t optimistic about his orthopedic colleagues’ ability, or willingness, to resist private equity. "We’re on an island and pieces are being chipped away by piranhas in the water," he said. "I’m not sure it’s possible to remain independent."

[Correction: This article was updated at 7 p.m. ET on Jan. 6, 2023, to remove the attribution to Sean Traynor in describing the impact of Welsh Carson’s investment capital and its growing size in major markets.]

Harris Meyer: @Meyer_HM

New efforts are underway an ongoing movement to make prices and upfront cost comparisons possible in a business known for its opaqueness.

This article was published on Monday, January 3, 2023 in Kaiser Health News.

By Julie Appleby

Need medical treatment this year and want to nail down your out-of-pocket costs before you walk into the doctor's office? There's a new tool for that, at least for insured patients.

As of Jan. 1, health insurers and employers that offer health plans must provide online calculators for patients to get detailed estimates of what they will owe — taking into account deductibles and copayments — for a range of services and drugs.

It's the latest effort in an ongoing movement to make prices and upfront cost comparisons possible in a business known for its opaqueness.

Insurers must make the cost information available for 500 nonemergency services considered "shoppable," meaning patients generally have time to consider their options. The federal requirement stems from the Transparency in Coverage rule finalized in 2020.

So how will it work?

Patients, knowing they need a specific treatment, drug, or medical service, first log on to the cost estimator on a website offered through their insurer or, for some, their employer. Next, they can search for the care they need by billing code, which many patients may not have; or by a general description, like "repair of knee joint," or "MRI of abdomen." They can also enter a hospital's or physician's name or the dosage amount of a drug for which they are seeking price information.

Not all drugs or services will be available in the first year of the tools' rollout, but the required 500-item list covers a wide swath of medical services, from acne surgery to X-rays.

Once the information is entered, the calculators are supposed to produce real-time estimates of a patient's out-of-pocket cost.

Starting in 2024, the requirement on insurers expands to include all drugs and services.

These estimator-tool requirements come on top of other price information disclosures that became effective during the past two years, which require hospitals and insurers to publicly post their prices, including those negotiated between them, along with the cost for cash-paying or uninsured patients.

Still, some hospitals have not fully complied with this 2021 disclosure directive and the insurer data released in July is so voluminous that even researchers are finding it cumbersome to download and analyze.

The price estimator tools may help fill that gap.

The new estimates are personalized, computing how much of an annual deductible patients still owe and the out-of-pocket limit that applies to their coverage. The amount the insurer would pay if the service were out of network must also be shown. Patients can request to have the information delivered on paper, if they prefer that to online.

Insurers or employers who fail to provide the tool can face penalty fines of at least $100 a day for each person affected, a significant incentive to comply — if enforced.

And there are caveats: Consumers using the tools must be enrolled in the respective health plan, and there's no guarantee the final cost will be exactly as shown.

That's because "unforeseen factors during the course of treatment, which may involve additional services or providers, can result in higher actual cost sharing liability," federal regulators wrote in outlining the rules.

Insurers will not be held liable for incorrect estimates.

Because the cost estimates may well vary from the final price, either because the procedure was more complex than initially expected, or was handled by a different provider at the last minute, one risk is that "I might get a bill for $4,000 and I'm going to be upset because you told me $3,000," said Gerard Anderson, a professor of health policy and management and of international health at the Johns Hopkins University Bloomberg School of Public Health.

Many insurers have offered versions of cost-estimator tools before, but small percentages of enrollees actually use them, studies have shown.

Federal regulators defended the requirement for estimator tools, writing that even though many insurers had provided them, the new rule sets specific parameters, which may be more detailed than earlier versions.

In outlining the final rule, the Centers for Medicare & Medicaid Services pointed out that some previous calculators "on the market only offer wide-range estimates or average estimates of pricing that use historical claims data" and did not always include information about how much the patient had accumulated toward an annual deductible or out-of-pocket limit.

The agency says such price disclosure will help people comparison-shop and may ultimately help slow rising medical costs.

But that isn't a given.

"CMS has a lot of people who believe this will make a significant impact, but they also have a long time frame," said David Brueggeman, director of commercial health at the consulting firm Guidehouse.

In the short term, results may be harder to see.

"Most patients are not moving en masse to use these tools," said Dr. Ateev Mehrotra, a professor of healthcare policy at Harvard Medical School.

There are many reasons, he said, including little financial incentive if they face the same dollar copayment whether they go to a very expensive facility or a less expensive one. A better way to get patients to switch to lower-cost providers, he said, is to create pricing tiers, rewarding patients who seek the most cost-effective providers with lower copayments.

Mehrotra is skeptical that the cost estimator tools alone will do much to dent rising medical prices. He's more hopeful that, in time, the requirement that hospitals and insurers post all their negotiated prices will go further to slow costs by showcasing which are the most expensive providers, along with which insurers negotiate the best rates.

Still, the cost-estimator tools could be useful for the increasing number of people with high-deductible health plans who pay directly out-of-pocket for much of their healthcare before they hit that deductible. During that period, some may save substantially by shopping around.

Those deductibles add "pressure on consumers to shop on price," said Brueggeman, at Guidehouse. "Whether they are actually doing that is up for debate."

Julie Appleby: jappleby@kff.org, @Julie_Appleby