Pricing Transparency In Healthcare Reform
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Transcript of Pricing Transparency In Healthcare Reform
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Pricing Transparency in Healthcare Reform
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Many Americans don’t know exactly how their healthcare
providers come up with prices.
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According to a recent report by non-profit Catalyst for Payment Reform, this is the fault of the providers themselves, who are rarely
transparent with their pricing methods.
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They recently gave 45 US states a failing grade for neglecting to provide a way for patients to understand their expenses.
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If patients had access to data like this, the argument goes, they would be able to properly budget for care
down the line.
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As it stands now, they are victims of prices as care is
needed.
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What this failing grade means is this: if you live there, you cannot
readily find healthcare prices.
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With healthcare reform, more of the cost of care is shouldered by patients,
which makes meaningful price information more important than ever.
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In the same way that consumers need to understand pricing of any
product they buy, they need to know what healthcare will cost them,
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particularly since we can expect
healthcare to be one of life’s biggest
expenses as we age.
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What’s standing in the way are
confidentiality agreements by
insurers, doctors, and hospitals.
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Price negotiations are kept behind
closed doors, and intentionally kept
secret.
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What results is that consumers won’t
have data to be able to choose care
providers.
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One reason this data would be important is
that the same procedure could have different
prices from hospital to hospital, or from doctor to doctor, with no difference
in quality.
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Sometimes the amount a
consumer’s insurance company
will pay can vary too, based on a number of factors currently not available to the
public.
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Larger hospitals or hospital systems
have greater leverage to get
higher reimbursement
prices from insurers.
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That extra money is paid by employers
and consumers with higher premiums and
deductibles.
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There has been a recent wave of
legislators bringing prices for such care
to the public, through laws
requiring transparency.
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Information repositories, also known as ‘all payer claims databases’ are
being constructed, providing accurate and complete information
about pricing by hospital and physician.
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As of now, such public databases are
only in Colorado, Maine,
Massachusetts, Vermont, and
Virginia.
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Florida is an interesting case, as
they’ve built a database, but still received a failing
grade.
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Their site is managed by the Agency for Health Care
Administration, and has been deemed to contain
too narrow a scope of information, as well as
being a clunky site.
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What information is present is not well displayed, or very
helpful.
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Florida’s legislators are also not seeking transparency from insurers, which is a necessary piece of the transparency
puzzle.
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Without this information, consumers only know
how much the care costs total, not how much they can expect to spend out
of their own pocket.
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Pricing Transparency in Healthcare Reform