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A message from our President

U.S. House Energy and cash price, payer-specific negotiated rates, and
deidentified maximum and minimum charges by
Commerce Committee to HHS: item/service.
For the top 100 hospitals in the Hilltop Institute
Enforce Price Transparency Rule study the results weren’t nearly as good. Sixty-five
percent were found to be noncompliant. Eighteen
percent didn’t provide any data files and 82 per-
cent didn’t provided identified payer-specific
A while ago, I wrote an article talking about price transparency. In the article, I negotiated rates. And, as we all know, there are
shared the goals and challenges associated with the effort and, at the time, the law always at least two sides to any story.
suit that the American Hospital Association had filed challenging the implemen- While not an excuse, the price transparency
tation of the rule. rule has some flaws. First, how is the customer
In a later article about the 2020 Presidential elections, I also talked about price assured that in comparing this data that they are,
transparency and noted that it was a subject that was not going to go away because in fact, comparing apples to apples? The rule
it had something that was very rare … bipartisan support! If you participated in the Jaime Caldwell doesn’t suggest what standardized codes should
University of Miami’s Business of Healthcare program on April 16, you heard former be included in creating the 300 shoppable services
Congresswoman and Secretary Donna Shalala interview former Secretary Alex Azar that include 70 services that are standard to all hospitals. So, one example used to
and when they got to the topic of price transparency, it was clear what the goals of illustrate this challenge is hospital A in creating the scope of services for their
transparency are and that there is support to move that ball across the goal line. shoppable service includes physician services in their profile whereas hospital B
The initial price transparency rule requiring the publication of hospitals’ charge- does not. There is no direction included in the rule to standardize what to include.
master data has given rise to new amended rules that hospitals provide data in two Then, even it they did, there is no requirement to look at comorbidities. We can
formats on their website that include hospital gross charges, discounted rate, and all understand that the challenges facing an 80-year-old are different that those
payer-negotiated rates. These formats are to meet the needs of two groups, first a facing a 21-year-old.
machine-readable file for healthcare stakeholders (business groups, insurers, etc.) Another issue to be dealt with is the fact that hospitals and insurers have entered
and a “consumer-facing” tool that allows prospective patients to search for the lowest into legally binding contracts that state that the information contained therein is
costs. Though the amended rule went into effect on January 1, 2021, the results are privileged and confidential. The disclosure of identified rates poses some liability
mixed and have given Congress the evidence they need to push Secretary Becerra to concern that has not been solved by everyone. I was thinking about this yesterday,
use HHS’ enforcement powers to gain compliance. it is like asking Amazon to disclose the MSRP, retail price, sale price, and, oh by
Powering this move by powerful House Energy and Commerce Committee are the the way, tell us what you paid for the item and from whom you bought it!
result of several recent studies that have looked at hospital compliance. First, the Wall Regardless, the fact that so many hospitals are out of compliance is concerning.
Street Journal found that, “164 webpages hosting disclosure files for 307 hospitals Especially concerning since, at the same time, hospitals are asking Congress for
that contained versions of that blocking syntax.” This syntax instructed search some big lifts. One was to rescind the first of two Medicare cuts (sequester), which
engines to not index the page, making it all but invisible to engines like Google. Congress did and saved hospitals around $18 billion. And, hospitals are also ask-
The Kaiser Family Foundation looked at the websites of two of the largest hos- ing, “Congress for relief from the American Rescue Act’s PAYGO obligation that
pitals in every state and the District of Columbia. They found that 81 percent of cuts $36 billion from Medicare funding.”
the hospitals displayed gross charges, but, only about half provided discounted Expect to see hospitals come into compliance with some of the issues hindering
rates. Of these 102 hospitals, only one-third provided payer-specific negotiated that effort being worked out. Also, expect to hear concerns from insurers who are
rates and only three percent were doing shoppable services. up next in providing pricing information. These are new times. As the Rascals
Similarly, Millman and the Hilltop Institute both looked at the same issue. sang in their song A Beautiful Morning, “It's a beautiful morning, ah - I think I'll
Millman looked at 55 health systems and Hilltop looked at the largest 100 hospi- go outside for a while - And just smile - Just take in some clean fresh air, boy - No
tals in the U.S. (by beds). In these studies, the hospital systems did better with 68 sense in staying inside - If the weather's fine and you've got the time - It's your
percent having, “at least one machine-readable listing gross charges, discounted chance to wake up and plan another brand new day - Either way …

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16 May 2021 southfloridahospitalnews.com South Florida Hospital News