Archive September 2019 XX, No. 9

Regulatory Affairs: How Transparent Is Healthcare Transparency?

The window into price and quality data could be as clear as mud.

Mark Weiss

Mark Weiss, JD

BIO

WINDOW DRESSING
WINDOW DRESSING Before you can get a clear picture into the financial guts of health care, you must first clean up your facility's financial operations.

However wonderful it might (or might not) be for healthcare pricing to be transparent, what does it matter if you have no clear understanding of related costing and other financial and billing matters within your operations?

With high hopes from some and loud mopes from others, President Trump recently signed an executive order directing federal agencies to develop regulations to foster transparency of healthcare price and quality data. Among many other directives, hospitals would publicly post standard charge information, including charges based on negotiated rates, and healthcare providers, health insurance issuers and self-insured group health plans would provide or facilitate access to information about out-of-pocket costs to patients.

As of this writing, CMS has released proposed rules that would require hospitals to:

  • make public their "standard charges" for all items and services;
  • post those charges on the internet in a machine-readable format that includes additional information such as common billing or accounting codes used by the hospital, so as to provide a common framework for comparing standard charges from hospital to hospital; and
  • make public payer-specific negotiated charges for common shoppable services available in a consumer-friendly manner.

As can be expected, consumer advocates applaud the notion of transparency in healthcare pricing. Hospitals, providers and payers, on the other hand, generally treat their negotiated rates as highly secure trade secrets. After all, once competitors know what rates a facility or medical group would accept, or can be had from a particular payer, the entity's competitive edge is instantly dulled.

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