Beginning this year, hospitals are required to be transparent about the prices they charge different insurers for their services. But, Samantha Liss reports for HealthcareDive that hospitals are not being transparent about their negotiated prices. Why would they post their prices when the potential penalty is a mere $300 a day or a corrective action plan, a flick on the wrist?
As of January 1, all hospitals across the country must make their negotiated prices public, online. Until this year, virtually all hospitals claimed this information was proprietary, a business trade secret. There was no requirement for price transparency.
Hospitals that are complying with the transparency policy are burying information about their rates on their web sites or are not providing complete information. Researchers cannot find it. There is no single designated place for this information.
The Centers for Medicare and Medicaid Services (CMS) is overseeing this effort. But, CMS does not post the information. It is not even collecting it; hospitals are not required to send CMS the information. There is no simple way to know which hospitals are complying and which are not.
When the hospital price information is available, it is not likely to help individuals compare prices right now. Over time, if you’re shopping for insurance, you might be able to see which insurers are able to negotiate the best rates from the hospitals you want to use. Of course, that does not tell you whether the insurer has inappropriately high denial or mortality rates, two other factors that people should be able to consider when choosing a health plan but for which there is no information.
The hospital price information currently available reveals what we already know. The prices vary tremendously for the same service. According to Niall Brennan, head of the Health Care Cost Institute, one insurer might pay $5,000 for a C-section and another $55,000. Neither Congress nor president-elect Joe Biden is even talking about fixing this huge problem that drives up insurance premiums and out-of-pocket costs and jeopardizes access to care.
The American Hospital Association fought hard against hospital price transparency. But, it ultimately failed. A federal appeals court wouldn’t intervene to block the policy from going into effect. The American Hospital Association tried to say that some prices are unknowable. Really? Do the hospitals make them up as they go along?
Here’s more from Just Care:
- The wrong choice of Medicare Advantage plan could kill you
- Inappropriate Medicare Advantage care denials appear widespread
- New law prevents doctors and hospitals from sending patients surprise medical bills
- Coronavirus: Medicare covers hospital care at home
- Three reasons why you can’t choose a health plan that’s “right for you”
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