It's among the biggest problems in American health care -- and one cause (among many) of the spiraling medical debt that saddles so many people: Who really knows how much a health care procedure costs?

As Hospitals Post Prices, Consumer Confusion Reigns

It’s among the biggest problems in American health care — and one cause (among many) of the spiraling medical debt that saddles so many people: Who really knows how much a health care procedure costs?

It’s a challenge that Sen. Maggie Hassan (D-NH) is trying to address in part through her proposed bill, the “No More Surprise Medical Bills Act of 2018.”

“Healthcare costs really just seem completely separated from actual market forces.”

– Sen. Maggie Hassan (D-NH)

As Sen. Hassan told us in a podcast: “I have been hearing from constituents for a while now, and certainly I’ve had family members who’ve had the same experience. You go to an emergency room, let’s say, and you believe you’re going to your local hospital that’s in your insurance coverage network and you get treated and you, all of a sudden, get a bill because some of the treatment you got, from somebody you never saw … let’s say a radiology technician or a lab technician … wasn’t considered in-network. I had a constituent who, on a Saturday night, cut his finger while he was cooking, went to his local emergency room, in-network hospital, and ended up with a bill for $3500 for his cut finger because one of the treating providers wasn’t in the network.”

“What this bill would do is just take the patient, the consumer, out of this dispute between an insurance company and a provider about how much the provider’s going to get paid. That’s really what is at the root of this. It would just say if you go to an emergency room for emergency care, the most you can get charged is what you would get charged for in-network services, and if you’re going to a provider for elective care, if there’s going to be anybody from out-of-network providing your care, you get advanced notice of that and have to consent to it, so that people won’t get these bills, which can be absolutely fiscally devastating.”

New Year, New Rules

To further try to address the problem, the New York Times reports that with the new year, “hospitals began complying with a Trump administration order to post list prices for all their services, theoretically offering consumers transparency and choice and forcing health care providers into price competition.”

Indeed, Centers for Medicare & Medicaid Services Administrator Seema Verma said in July: “CMS has proposed requiring that hospitals become more transparent with their pricing.  This is a small step towards providing our beneficiaries with price transparency, but our work in this area is only just beginning. Price transparency is core to patient empowerment and making sure American patients have the tools they need so they can make the best decisions for them and their families.”

The NYT verdict: “It’s turning into a fiasco.”

The piece continues: “The data, posted online in spreadsheets for thousands of procedures, is incomprehensible and unusable by patients — a hodgepodge of numbers and technical medical terms, displayed in formats that vary from hospital to hospital. It is nearly impossible for consumers to compare prices for the same service at different hospitals because no two hospitals seem to describe services in the same way. Nor can consumers divine how much they will have to pay out of pocket.”

In previewing the changes, Healthcare Dive reported back in August: “As for pricing transparency, the final rule requires hospitals to “make public a list of their standard charges via the Internet in a machine readable format, and to update this information at least annually.” Patient advocate organizations may find this transparency effort somewhat toothless, as CMS had already required hospitals to make their standard charges public. However, CMS’ supplementary RFI acknowledges swathes of opacity in pricing that need to be addressed.”

And now as the changes are being implemented, Gerard Anderson, director of the Johns Hopkins Center for Hospital Finance and Management. told CNN: “I don’t think it’s very helpful. There are about 30,000 different items on a chargemaster file. As a patient, you don’t know which ones you will use.”

Future Focus: Legislative Efforts to End Medical Debt

The confusion and pushback returns the focus to Sen. Hassan’s bill and other legislative efforts.

After all, as Sen. Hassan said in the podcast, “Healthcare costs really just seem completely separated from actual market forces. What this bill is trying to do is get both the insurer and the provider to be reasonable, first, to see if they solve it without an arbitrator in the middle of it, but, secondly, to really try to get them to propose reasonable solutions to this. We try to do our part in this bill to change this upward trend of healthcare costs.”




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