Infighting continues over healthcare pricing transparency rule
Monday, May 18, 2020
The healthcare price transparency argument continues. The latest battlefront came with the Centers for Medicare & Medicaid Services (CMS) adding a new element to its policy, saying it plans to collect data on hospital median payer-specific negotiated rates. That information could be used to set Medicare payment rates.
Hospitals, of course, immediately returned the volley. It’s not a new development that health systems and some payers loathe the idea of making their pricing models and negotiated rates public.
The American Hospital Association (AHA), one of the largest armies of lobbying groups, said the following in a statement: "We are very disappointed that CMS continues down the unlawful path of requiring hospitals to disclose privately negotiated contract terms. These rates take into account any number of unique circumstances between a private payer and a hospital and simply are not relevant for fixing Fee-for-Service Medicare reimbursement."
The AHA maintains its lawsuit against the federal agency for previous iterations of a transparency rule. In arguments made in the U.S. District Court for the District of Columbia, the lobbying group said the transparency mandates to disclose secret negotiated prices violate the First Amendment, as the data are protected proprietary information.
Many such companies want the Department of Health and Human Services (HHS) to clarify privacy stipulations and slow the pace of regulatory changes, especially during the COVID-19.
The proposed rules are part of a broader, five-year roadmap released in mid-January. It is being used by federal agencies to coordinate initiatives, proportion resources, and align with the private sector as HHS implements the 21st Century Cures Act.
Called a high-level view of HHS’ battle plan, it will guide agencies like the Department of Veterans Affairs as they work on their own health IT initiatives.
Among the price transparency push, the plan also attempts to make quality information public, including social determinants of health data in EHRs to reduce provider burden by streamlining healthcare software and apply artificial intelligence (AI) and machine learning to patient matching.
Making pricing information public, CMS argues, will help to alleviate and bring down staggering continual rises in healthcare costs.
Payers, who are significantly put off by the idea of making negotiated rates public, say American consumers don't want such detail, but instead want only their specific out-of-pocket information for procedures.
In its comments, UnitedHealth Group, which owns the largest private payer in the U.S., said it doesn't support any policies publicizing information that would "mislead consumers about their out-of-pocket costs, undermine health plan competition or increase prices."
The Blue Cross Blue Shield Association, a national group of 36 BCBS plans, agreed with its competitor.
Opposition to the plan remains fierce and is hotly contested. Parts of it are currently being litigated in district court.
The final rule includes bringing consent into the patient authentication process. HHS says that patients will know what they agree to and be apprised of any potential privacy concerns before exporting their data.
Comments on the proposed rule are due July 10.
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