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New Year’s Day marks the second anniversary of the Federal Hospital Price Transparency Rule, which has the potential to significantly reduce the exorbitant medical costs that burden patients, workers, businesses, and taxpayers. The Centers for Medicaid and Medicare Services recently announced that the US will spend her $4.3 trillion on healthcare in 2021. This is almost 20% of GDP, almost double the average for developed countries. The Biden administration can mark the occasion by promising to firmly enforce the rules to make them a reality for America’s healthcare consumers.
This rule addresses the root cause of exorbitant hospital prices. The hospital’s opaque billing practices blind consumers to prices, with high bills that they often would not agree to if the price was known in advance. Hospitals must publish discounted cash prices and negotiated premium rates for each health insurance plan. Armed with this information, consumers can investigate wide, well-documented price fluctuations for the same treatment, even in the same hospital, to avoid price spikes and access treatment at fair market prices. increase.
Strong price transparency allows hospitals to take responsibility for egregious overcharges such as a $5,000 MRI and $100,000 knee surgery that cost $250 and $18,000, respectively, at cash-based centers. Employers and unions who know price data can profit from competition. Price discovery provides quality transparency.
Consider union SEIU 32BJ. The union saved him $30 million on health insurance by purchasing care. The company recently removed New York Presbyterian Hospital from health insurance after analyzing claims data and determining that the hospital was inflating member prices. For example, the hospital charged the plan an average of $10,368 for an outpatient colonoscopy versus $2,185 for him at a city public hospital. Hospital price transparency will make it easier for other employers and unions to follow in his SEIU 32BJ footsteps and significantly reduce healthcare costs.
Unfortunately, price transparency rules are undermined by widespread hospital non-compliance.
According to a recent study by PatientRightsAdvocate.org, only 16% of hospitals nationwide follow it. Most do not publish prices broken down by health insurer or plan where appropriate, and some do not post prices at all.
By refusing to comply, hospitals perpetuate the pricing fraud that has put 100 million Americans into medical debt. This patient misery funds the hospital’s private equity. The country’s “non-profit” hospitals have more than $283 billion in financial assets, investing Wall Street style to generate higher returns. HCA Healthcare, the largest private healthcare system in the United States, will make $7 billion in profits in 2021.
CMS has helped hospitals by choosing not to strictly enforce the rules. Out of thousands of hospitals nationwide, only two are not compliant. But even this slight response shows that enforcement is working. The two fined hospitals quickly complied and posted exemplary price files.
At a conference earlier this month, CMS administrator Chiquita Brooks-LaSure was uncertain about future enforcement, stating: share. ”
This lack of determination is out of step with the American people. According to a new Kaiser Family Foundation poll released last week, 95% of Americans want policymakers to make healthcare cost transparency a key priority.
The second anniversary of the Hospital Price Transparency Rule is an opportunity for the Biden administration to stand up for America’s healthcare consumers and step up to properly enforce the rule. In doing so, we can create a consumer revolution that ushers in a functional and competitive healthcare marketplace, stop overcharging hospitals and reverse exorbitant national healthcare costs.
Cynthia A. Fisher PatientRightsAdvocate.org
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