Industry Orgs Express Concerns with Healthcare Price Transparency | RevCycle Intelligence

PATIENTS SEEK OUT-OF-POCKET COSTS, NOT PROVIDER/HOSPITAL PRICES
With provider-level prices hard to determine, relying on chargemaster or estimated costs is not adequate for healthcare price transparency, several groups argued.

Chargemaster prices are especially problematic to give to consumers because patients rarely pay that price, HFMA told the Senators.

“Information on charges or on average charges is of limited value to consumers, as it will likely be significantly different from the amount they will be expected to pay,” the group argued. “Chargemaster prices serve only as a starting point; adjustments to these prices are routinely made for contractual discounts that are negotiated with or set by third-party payers. Few patients actually pay the chargemaster price.”

Instead of making provider-level prices accessible to consumers, the healthcare price transparency initiative should focus on sharing out-of-pocket costs. Patients undergoing the same procedure could end up paying different amounts based on their health plan. Therefore, out-of-pocket cost information is more valuable to consumers, FAH argued in a separate letter to the Senators.

“In our view, effective price transparency should involve the release of information that is clear, accessible, and actionable so that consumers easily can determine the cost of their premiums, deductibles, copayments, and non-covered services (out-of-pocket costs), prior to purchasing health insurance coverage as well as receiving medical services,” the group wrote. “This will allow consumers to make meaningful comparisons to help inform patient-centered care choices.”

Increasing out-of-pocket cost transparency also allows consumers to select the health plan that is most appropriate for their healthcare needs.

With industry groups agreeing that out-of-pocket cost information is the best type of pricing data to give to patients, payers need to lead the effort to increase healthcare price transparency for insured patients, FAH contended.

“For consumers with health insurance, the health plan should be the consumer’s primary point of contact for ‘one-stop’ shopping for all information related to insurance coverage and payment, including out-of-pocket costs,” the group wrote. “Providing such information is simply not feasible for providers. Providers deal with an overwhelming number of insurance companies, and even more plans offered by those insurers, each with specific coverage requirements and out-of-pocket cost requirements for enrollees.”

On the other hand, providers should take responsibility for increasing healthcare price transparency for uninsured individuals. Uninsured patients and those who have yet to hit their deductible are the only individuals paying provider or hospital prices.

State databases and hospital websites are key resources for improving healthcare price transparency for uninsured patients, FAH stated. Although the information may be limited due to the numerous factors involved in providing comprehensive care.

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Industry Orgs Express Concerns with Healthcare Price Transparency.