Imagine going to the grocery store, getting your weekly groceries, but not knowing how much it would be until you receive a bill in the mail weeks later. Imagine getting an oil-change or going on vacation and not knowing the cost. This is exactly what happens to millions of patients each and every day, and a big part of what is broken in our healthcare system. In fact, the Kaiser Family Foundation found that 67 percent of individuals are concerned about unexpected medical bills. (1)
Competitive pricing is an essential part of nearly every industry across the nation. So why has healthcare managed to escape? Why is the cost of care rarely revealed or understood until it is time to pay the bill? Although healthcare is much more complex than going on vacation or getting an oil change, the truth remains that unexpected healthcare costs have been plaguing patients nationwide for decades. While a solution may be unclear at this point, it seems as though the issue may have finally been addressed.
In Jan. 1, 2019, the Trump Administration required all hospitals to post prices for their services. While many believe this was a step in the right direction, this has been easier said than done. The result has been confusion over deciphering the complex pricing information, it is not consumer friendly, and most believe it falls short of what is truly needed.
The Centers of Medicare and Medicaid Services have recently voiced their commitment to price transparency and released a new Medicare.gov tool https://www.medicare.gov/procedure-price-lookup/ that enables consumers to compare Medicare payments and co-payments for certain procedures in hospital outpatient departments and ambulatory surgical centers. According to CMS, this initiative is just the beginning of their efforts to increase price transparency throughout the healthcare system.
Additionally, the issue of “surprise billing” and lack of price transparency continues to gain scrutiny from the White House and Congress. In fact, large hospital groups such as American Hospital Association, The Federation of American Hospitals, Catholic Health Association, and others have indicated they want to take part in addressing the problem.
Recently, the group sent a letter to Congressional leaders, calling for principles they would like lawmakers to consider as they work to address the issues of surprise billing. The following were some of their requests:
- Define “surprise bills”
- Protect the patient financially.
- Ensure patients access to emergency care.
- Preserve the role of private negotiation.
- Remove the patient from health plan/provider negotiations.
- Educate patients about their health care coverage.
- Ensure patients have access to comprehensive provider networks and accurate network information.
- Support state laws that work.
As the debate continues, and the answers remain unclear, the need for cost transparency in our healthcare system is more apparent now than ever before. The lack of accurate and timely healthcare price information prevents patients from having a clear understanding of fees until after a procedure, pharmacy visit, or physician appointment.
Cost transparency remains a key factor in the efficiency of our healthcare system, and why it is so different than any other industry in our nation. Once patients are in the driver’s seat with accurate quality and price information, they can see the complete picture and will be more empowered to take an active role in their healthcare while finding the best possible value, quality, and cost.