Medical Providers Are Giving Us The Run Around On Healthcare Price Transparency And It Needs To Stop

Now that the Supreme Court decision upholding subsidies for state exchange enrollees has come and gone, we need to focus on the biggest issue still plaguing health care reform--health care and prescription drug prices. Doctors, hospitals and pharmaceutical companies charge whatever prices they want for their services and products. And we have no idea how much we have to pay until we receive care. However, things are changing. As consumer healthcare cost sharing increases, so does the demand for upfront healthcare prices.

Excuses, Excuses

But our demand is meeting their excuses. Even though about
70% of states and the federal government have regulations in place requiring hospitals, medical providers and/or insurers to produce price lists they keep coming up with reasons why they can’t comply. Or, they send their lobbyists to make sure the legislation is so watered down that the data is useless. Really, how useful are average prices when some areas in a state can charge 1,000 times as much for the same medical procedure.

Of course we should listen to the healthcare industry’s concerns about providing healthcare price data. But we can’t allow them to continue to stall providing this data. Especially as they continue to rake in money and send patients who cannot pay to collection agencies. Besides, it’s been over a decade since we started seriously requesting healthcare price data and they are still using the same excuses for not providing it. Yeah, you know what they are:

  • Price data are trade secrets
  • Price data is meaningless without quality data
  • Prices are difficult to estimate due to the many variables in treatment
  • Price data is difficult to compile and format because of outdated computer systems
All of these excuses have been exposed for what they are—delaying tactics. And what these decade-long delaying tactics tell us is that healthcare providers are not willing to share price data with the public. Therefore, we need comprehensive legislation at the federal and state levels to force them to. No more compromises and no more delays.

Mandating Price Transparency Through Legislation

If healthcare providers won’t share their price data willing, we have no choice but to mandate their compliance. At a minimum, healthcare price transparency legislation should require:

  • providers to post medical charges and prices on every medical bill. Patients should know what the hospital, medical entity and medical provider charges before any insurance discounts.
  • every hospital, medical entity and medical provider to share financial aid information with patients before they can send the patient’s account to a collection agency.
  • every hospital, medical entity and medical provider to publish their chargemaster for each health plan on the Internet and prominently post the web address on their primary website, at each facility and all patient billing.
  • every hospital, medical entity and medical provider to designate an individual or department to answer all price inquiries and prominently post this information on the website, at each facility and on all patient bills.
  • all price estimates include out-of-network provider care and additional services such as anesthesiology, reading of test results, and prescription drugs.
  • individualized price estimates based on the patient’s health insurance plan and status.
  • price ranges (low, median and high), not averages.
  • price data for uncommon, non-emergency procedures on an individual basis.
  • payment of a tax (paid by health insurers, hospitals and other medical entities and medical providers) to finance the creation and maintenance of national price database standards.
  • strict timelines for compliance and stiff monetary penalties for noncompliance.

The healthcare provider community is sending a strong message that healthcare price transparency is so not a priority to them. They have some legitimate concerns about gathering data, but mostly they have old excuses designed to delay sharing this data with the public. The only way this country can provide its citizens with comprehensive and easy to access healthcare price data, is to pass strongly worded legislation demanding it. If providers don’t have the time and resources to provide this data independently, we should tax them and help them build a universal system we can all access.

No more excuses about the difficulties of providing data that they provide everyday in the form of a patient bill.
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