Fatal flaw in hospital price transparency rules

The following is an excerpt from MedPage Today.

The Hospital Price Transparency rule celebrated its first birthday in January, and as of July 1, the enforcement of a similar requirement for payers and health plans began through the Transparency in Coverage rules.

Regrettably, the U.S. is still far from achieving price transparency’s intended outcomes (more shoppable healthcare), or perhaps even understanding what the outcomes are supposed to be.

Key compliance metrics vary, and indeed there is also variance in the very definition of “compliance,” which has resulted in estimates ranging from as low as 6% to more than 50%, depending on how you slice the data.

True “compliance” means that a hospital has published price data that is both user-friendly and located prominently on their website (and yes, this includes making the information easily retrievable via search engines).

By this definition, compliance is undoubtedly low since many hospitals have not created accessible resources to locate and understand their pricing.

While price transparency rules are well-intentioned, they suffer from a fatal flaw: too much room for interpretation in the definition of compliance. 

Vague requirements and a lack of repercussions have not created the sense of urgency that regulators hoped for. So where do we go from here?

If the industry hopes to improve compliance, then the Centers for Medicare & Medicaid Services (CMS) must lay out clear rules, including what is expected and what is forbidden, and ensure they have closed any potential loopholes in the process.

Remember that hospitals tried and failed to block these transparency requirements in the courts.

Many providers view this rule as more of a regulatory compliance burden than a potential opportunity to distinguish themselves from their competitors and increase market share, so they see little incentive to comply. (Continued)

Read entire article here.

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