last posts

Making the Hospital Price Transparency Rule a Reality on Its Second Anniversary

techsm5

The New Year marks the second anniversary of a federal hospital price transparency rule that has the potential to dramatically reduce outrageous health care costs that weigh on patients, workers, businesses and taxpayers. The Centers for Medicaid and Medicare Services recently reported that the country spent $4.3 trillion on health care in 2021, nearly 20% of GDP and nearly twice the average for developed nations. The Biden administration can mark this occasion by pledging to vigorously enforce the rule to make it a reality for American health care consumers.

The rule tackles the root of exorbitant hospital prices: opaque hospital billing practices that blind consumers to prices, then blind them with inflated bills they often would never have accepted if prices were known at advance. It requires hospitals to publish their discounted cash prices and negotiated insurance rates by health plan. Armed with this information, consumers can investigate wide, well-documented price variations for the same care, even at the same hospital, to avoid price gouging and access care at fair rates.

Strong price transparency can hold hospitals accountable for egregious overcharges such as $5,000 MRIs and $100,000 knee surgeries that cost $250 and $18,000, respectively, at cash centers. Employers and unions knowing the price data will allow them to benefit from competition. Price discovery will usher in quality transparency.

Consider the SEIU 32BJ union, which saved $30 million on its health plan by purchasing care. It recently removed New York-Presbyterian Hospital from its health plan after analyzing its claims data and determining that the hospital was raising prices for its members. For example, the hospital billed the plan an average of $10,368 for outpatient colonoscopies compared to $2,185 at public hospitals in the city. Transparency in hospital pricing can make it easier for other employers and unions to follow in SEIU 32BJ’s footsteps and significantly reduce healthcare costs.

Unfortunately, the price transparency rule has been marred by widespread non-compliance by hospitals.

A recent study by PatientRightsAdvocate.org reveals that only 16% of hospitals nationwide follow it. Most do not publish their prices broken down by health insurer and plan as required, and some do not display any prices at all.

By refusing to comply, hospitals are perpetuating a pricing scam that has burdened 100 million Americans with health care debt. This misery of the patients finances the capital investment of the hospitals. The nation’s “nonprofit” hospitals sit on more than $283 billion in financial assets that they invest Wall Street-style to generate even higher returns. HCA Healthcare, the nation’s largest private healthcare system, made $7 billion in profits in 2021.

CMS has helped hospitals by choosing not to strictly enforce the rule. It imposed financial penalties on just two hospitals out of the thousands of non-compliances nationwide. Yet even this meager response indicates that the app is working. The two sanctioned hospitals quickly brought themselves into compliance and posted exemplary price sheets.

At a conference earlier this month, CMS administrator Chiquita Brooks-LaSure was non-transparent about future enforcement, saying, “We have a lot of priorities, and the things we will do in terms of application are still ongoing and not things we share.”

This lack of determination is out of step with the American public. According to a new Kaiser Family Foundation poll released last week, 95% of Americans want policymakers to make health care pricing transparency a top priority — more than any other health care reform proposal.

The second anniversary of the hospital price transparency rule is an opportunity for the Biden administration to stand up for U.S. health care consumers and step up proper enforcement of the rule. It can generate a consumer revolution that ushers in a functioning and competitive health care market that stops hospital overload and reverses outrageous national health spending.

Cynthia A. Fisher is Founder and President of PatientRightsAdvocate.org

techsm5

Comments



Font Size
+
16
-
lines height
+
2
-