(Nov. 22, 2019) – By now, you know the Trump administration recently released a final rule requiring hospitals to disclose payer-specific negotiated rates. Also released was a proposed rule that would impose new requirements on private insurers in the individual and group markets to publicly disclose negotiated rates and out-of-network allowed amounts, and give their enrollees real-time, personalized access to cost-sharing information.
As we pointed out in a memo distributed to our members earlier this week, the final rule has three major areas: Posting of Standard Charges, Listing of Shoppable Services and Penalties (see CMS Releases Final Rule on Price Transparency for more delatils). Pushback against the rule, especially from provider groups, has been severe.
I agree with the American Hospital Association that the rule will "introduce widespread confusion, accelerate anticompetitive behavior among health insurers, and stymie innovations in value-based care delivery." I also applaud AHA's determination to challenge the rule in court on the basis, among other things, that the Trump administration has exceeded its statutory authority. Indeed, the goal here should be to provide patients with the information they need to make informed health care decisions and know what their expected out-of-pocket costs will be, not insert even more confusion into the health care finance system and publicly humiliate providers in the process.
Let's be clear, though. This discussion is about how best to achieve more transparency in healthcare, not whether to do so. The lack of price transparency in healthcare has increasingly been seen by both patients and policymakers as a sign that our system is broken. Our job must be to help craft the kind of transparency that is crucial to a well-functioning market—the kind that is actually helpful to those attempting to make important healthcare decisions.