HFMA: Healthcare Pricing Transparency a Shared Responsibility

Christopher Cheney, for HealthLeaders Media , April 30, 2014

"The report offers several examples of how information can be made easily accessible: Providers might post procedure prices on a public website, or provide information on how to make phone or email inquiries to pricing specialists. Many payers, as well as third party vendors, are already offering transparency tools for their members that enable them to make price and value comparisons among multiple providers."

Achieving the price transparency goals will require cooperation between healthcare providers and payers, Gundling said. "Transparency will work best when there is collaborative agreement between providers and payers on the right 'metrics' for transparency, offering different or potentially conflicting information will ultimately create confusion for care purchasers."

"And both payers and providers need to be responsive to feedback from patients/health plan members on what information they find useful when choosing a provider. The HFMA report includes a recommendation to establish "different price transparency frameworks for different care purchaser groups," he said.

For insured patients, the report recommends payers serve as the main source of price information. Providers are best suited to provide price information to uninsured and out-of-network patients, the report contends. And fully insured employers should use and expand transparency tools that help workers identify higher-value providers, according to the report.

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4 comments on "HFMA: Healthcare Pricing Transparency a Shared Responsibility"

Jack Durbin (4/30/2014 at 1:57 PM)
I would add to the information shared about pricing transparency the tension between services delivered at a hospital compared to a clinic or outpatient center. There are significant added costs to provide a 24/7 full service facility compared to a M/F day time service. Even for patients with insurance, increasing deductible costs are making patients select the point of care with the lowest cost as that is the usual basis for their out-of-pocket expense. What they don't realize is that in smaller communities, these choices may make the difference in the scope of services that the local hospital may continue to be able to offer.

Fritz Stephens-Tiley (4/30/2014 at 12:21 PM)
As usual this article has missed the boat. The notion of "price" transparency is irrelevant when you have providers setting their "prices" at, in most cases, over 200% of their costs. Cost data is freely available via CMS cost reports that hospitals are required to submit annually. The health care industry is a cash cow for those willing to exploit it. Insurance companies are no better when they consistently do a poor job of negotiating with providers for more realistic reimbursement rates. They simply pass any rate increases to their members in annual premium hikes. The "Free Market" has failed us.

Cody (4/30/2014 at 10:12 AM)
While pricing transparnecy is the responsiblity of the provider, once pricing is provided it's the responsibility of the patient to pay for their care. A lot of what is being missed in what is being described in most articles related to hospital pricing is the fact that a majority of patients don't meet their payment obligations. Thus the ever increasing amount of hospital bad debt and uncompensated care. In addition, not often mentioned is the self pay discounts, charity and other forms of discounts provided to patients. As with most people that have bought a car, you rarely pay the "sticker price".




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