The Trump administration just issued a new set of rules to address why patients don’t have the power to make choices that reflect what’s best for them and for their pocketbooks. These go a long way to restore price transparency in health care so that we can access price information when it matters — ahead of time. Yet they need to hear from the public about some of the problems that these rules don’t address.
Why is it that when we consume almost anything else, we have detailed information up front about what price we will pay, but in health care, we must wait until after the fact? (And often face unpredictably and unbelievably high prices?)
It’s not sufficient to say that health care is an emergency; the vast majority of health services are pre-planned. In fact, over 90 percent of healthcare spending is not emergency care, but it’s routine, expected, or to use another word, it’s “shoppable.”
But when we ask what these services (or treatments, procedures, or drugs) will cost, we’re often met with the answer “it depends.” It depends on our insurance plan, our employer, and under what conditions or settings the care was delivered. This isn’t fair or conducive to a functional marketplace where consumers hold the power to make decisions and providers compete to provide value and keep costs low.
The administration’s proposed rules would require hospitals and insurers to share real net prices for healthcare services. Such changes could dramatically change how Americans shop for and consume health care, because they’d infuse our system with information, competition, and accountability.
As is always the case in Washington D.C., especially with regulatory changes (which are often drafted behind closed doors by faceless bureaucrats), there are special interests that advocate for the status quo if the status quo serves them well. The same is true when it comes to patients knowing prices and being able to shop and compare. Naturally, there are hospitals and insurance companies who benefit from keeping patients in the dark.
It’s worth noting that not everyone in the healthcare industry are bad; some have taken admirable steps to offer patients better information. But overall, healthcare lobbying efforts have generally opposed price transparency measures.
But price transparency isn’t for the industry; it’s for the patient. It’s critical that the administration adopt rules that keep the patient as the focus and avoid a few potential pitfalls that could render this price transparency effort ineffective:
First, special interests are fighting to change the definition of health information (as defined by HIPAA) to include only clinical information (e.g. what tests did you receive, what were the results, what was your diagnosis?) and not pricing information. Patients understand that our right to our health information should include prices. If we are expected to pay the bill, we should have the right to know what the bill will say.
Second, the regulations as currently drafted include a fine for noncompliance: a laughably low $300 per day. This is pocket change to hospitals and won’t produce any real change. This is simply a pay-to-not-play option. Any requirement must come with real teeth or it will be ineffective, as anyone familiar with the Affordable Care Act’s individual mandate should know.
Third, there’s an effort to offer hospitals an “out” from price transparency requirements if they offer an internet-based price “estimator” tool. This isn’t real price transparency. These tools always come with a disclaimer about how they are not guaranteed prices and can’t speak to an individual patient’s situation. This should not be an option for hospitals under the new price transparency rules. They should have to offer a firm, transparent price for their services just as sellers do in practically every other industry.
For the sake of fairness, and for the sake of patients, regulators should make rules that are simple and easy to follow, that don’t mix up definitions that are established in current law, that don’t purport to require something but without real enforcement, or that offer too easy an alternative that won’t actually help patients.
Sadly, the Swamp is alive and well in Washington, D.C. Information — about prices and about policymaking — is the best power we have to fight for what’s right. So contact HHS, and let them know that these are great rules for patients, but they need to get these details right for them to work.