RIP Price Transparency, We Barely Knew You
Episode 8329th April 2021 • This Week Health: News • This Week Health
00:00:00 00:11:30


This transcription is provided by artificial intelligence. We believe in technology but understand that even the most intelligent robots can sometimes get speech recognition wrong.

  Today in Health it, this story is Rest in peace. Price Transparency for healthcare. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in Health, IT at channel dedicated to keeping health IT staff current. I. And engaged. Today, we have no show sponsor. So if you're listening to this, you know the power of podcasting.

Our show started a little over 90 days ago, and we are approaching 10,000 downloads for every 90 days, and that number is only going to grow. If you wanna get your message in front of a targeted healthcare audience, send an email to partner at this week in health It. Dot com. Alright, here's today's story.

Sometimes my crystal ball gets a little cloudy and I misread the tea leaves, so I have to backtrack on something I said to make sure that you're heading in the right direction. I believe that there were signals that this administration was going to continue with price transparency rules, but today I'm gonna rescind any urgency you may have felt to comply with price transparency.

If I were a healthcare CIO today, I would put this one on the back burner. I would reduce the team working on this and the funding that I've allocated to this to as little as possible. I. There is no carrot and it would appear that there will be no stick, either. The status quo has been defended and that is what we need in healthcare.

More status quo now to the article and I, I will apologize ahead of time. My, I. Reporting this morning, it's gonna be loaded with cynicism because I read this article and it just makes me laugh every time I read it because it is so overtly partisan towards hospitals and the status quo. And make no mistake about it, this is a win for the status quo for healthcare.

They give a microphone to the lobbyists, and the lobbyists, again, just make me laugh at some of the things they do. They, they essentially say. You know, it doesn't, it's not gonna make any difference. It's too hard to track. Hey, look at the payers, don't look at the providers. I mean, it, it really is kind of funny.

I'm sorry, I'm gonna go into it. So. And it starts right from the, from the headline. To be honest with you, Biden won't pull the plug on Price Transparency Experts say, which is a completely misleading headline. What it really should say is Price Transparency, which was designed to help consumers, is now gonna be used as a tool to combat the health insurance industry, which you'll see as we get into the article.

So let's get into the article. CMS plans to stop requiring Hospitals to report their median payer specific negotiated charges with Medicare Advantage insurers. Is a win for hospitals and it is a win for hospitals and the status quo. By the way, experts said. That it's an easy way for the Biden administration to reduce administrative work for providers without giving up much in the way of price transparency.

But it probably doesn't say much about the Biden administration's thoughts on price transparency according to Avalara Health consultant, Tom Cornfield, which I don't think is correct, and you'll see that later in the article. I wouldn't read anything more into this, but it, it is a push for some administrative simplicity.

Lauren Adler, associate director of the USC Brookings Schafer Initiative for Health Policy sent an email. I. She goes on to say, and this is where it gets, uh, I mean again, just kinda silly price transparency policies concerning Medicare Advantage rate information wouldn't do much to affect healthcare costs or spending because Advantage plans paid nearly the same rates.

on to site that according to:

This is money going in and out of a hospital, something that I think . We have accused the EHRs of being designed specifically for over and over again that they are really administrative tools to track the money going in and out of a hospital. How hard is it to track this information and provide it? But this is one of the main reasons that's given.

Oh, it's gonna take too many hours to track this and get this information out there. That's one of the main reasons that they think we shouldn't be doing this. And the second is it's not going to make . Any difference? I'll get to that. In the so what? The price transparency was central to the Trump administration's healthcare agenda.

As CMS includes such requirements throughout its policies, and while there continued to be bipartisan support for greater transparency, which of course there is, because we are used to transparency in every other aspect of our lives, we make no purchase decision without shopping. We make no purchase decision without knowing the quality of the product that we're getting, the quality of the doctor or the price that we're gonna paying, as opposed to where else we can go, but.

It's healthcare, so we don't need to know the quality of our doctor, nor do we need to know the price that we're gonna be paying for a procedure. Many experts thought that Medicare Advantage requirements were misguided from the start. And who are these experts? I, I, I'd like to hear from these experts.

Here we go. This was not a well thought out policy in the first place. It was really a waste of everybody's time. In the name of Transparency Federation of American Hospital, CEO, chip Khan, a lobbyist and the lobbyist organization. So our experts are lobbyists. Oh, it goes on, there's, there's another expert.

Hospitals strongly opposed the policy in part because Trump's CMS. Didn't do comprehensive analysis of how a market-based pricing approach would affect diagnosis related group payments, DRGs, or explain why it would be beneficial to the healthcare system as a whole. Said Joanna Hyatt Kim, vice President of Payment Policy and Analysis for the American Hospital Association.

Another lobbyist organization CMS was really conflating market-based prices with costs. You know, I might as well address this now. Because their argument isn't incorrect in that doing this transparency was not going to immediately impact the patient. And this wasn't about the patient, this was about changing the system.

When you do a transparency move, it's not necessarily about changing behavior right away. It's about changing the system. It is about shining a light into the healthcare system and the negotiated rates that are happening, and by doing that, it changes behavior, behavior of the system and starts to change the system so that we can have

Activated consumers and activated patients who are making decisions based on the information that they're being provided. Let's go down further in the article. Hospitals are hopeful that coming surprise billing regulations from CMS will allow the agency to pull back other price transparency requirements that don't directly help consumers understand their financial obligations.

Conn. And Smith added. Okay, so they're gonna use, I, I have no idea how they're gonna do this. This is another thing that just makes me giggle. Hospitals are hopeful that the surprise billing regulations, the thing that is meant to help to eliminate surprise bills for patients, are gonna somehow pull back even more price transparency.

I wanna know how we're gonna get a, a better view into surprise bills. And also pull back more price transparency. But this is what they are hoping for because they represent hospitals and we have eliminated the work of hospitals and we have allowed the hospitals to operate in the dark with little light being shown into the process.

And price transparency experts said it makes far more sense to focus price transparency efforts on commercial health plans. Since there's much greater variation in the rates provided in negotiations with them. And uh, I'm sorry. The reason that makes me laugh is 'cause remember the experts are the American Hospital Association and what was the other lobbyist group?

Federation of American Hospitals, CEO. So the experts say, don't focus on the hospitals, focus on the payers, and this makes sense. The Biden administration is essentially . Heading in that direction anyway. They want Medicare advantage for all. They want a single payer system and you have to have a fall guy.

And the fall guy for this will be the insurance carriers and we're gonna cut them out completely and essentially force them into life insurance and other things. And we are gonna partner with the hospitals, which, you know, like trust and love, and the federal government, which, you know, like trust and love.

And we're gonna come together and we are going to take care of you. And by the way, we're not gonna have any transparency behind that, which of course, this takes care of price transparency for Medicare Advantage. With all these transparency efforts already out in the world. The case for a national all-payer claims database becomes even more clear.

Cut Adler said, A national all-payer claims database could prove useful over time for identifying issues in the healthcare system and crafting reforms again towards a single payer system. And while the Biden administration will continue price transparency initiatives, they probably won't drive its healthcare agenda.

Experts said Biden administration is likely more willing. Then his predecessors to pursue other legislative or regulatory changes to reign in healthcare costs, including price setting, which we did talk about earlier. We did expect more bundled payments and those kind of things, a return to bundled payments, which is what the mode of operation was during the Obama administration.

Alright. I already gave you the so what on this? This is a big win for the status quo, which means you don't really have to do anything with regard to price transparency and the, the reality is, I would reduce my budget going towards this. I'd reduce the staffing going towards this. I'd reduce the number of meetings I have going towards this because there's gonna be no carrot and stick.

And again, you don't have to do anything with regard to price transparency. That is, unless you claim to be consumer-centric, mission-based or operating in the best interest of your community. If you don't happen to fall into any of these categories, forget about it. It's an added expense to your budgets that you don't have time for it.

Invest in EHR optimization digital tools, telehealth. Why shine the light in the darkness when you can let people grope around trying to find . The best healthcare for their family. I was raised on good old Catholic guilt. How'd I do? That's all for today. If you know of someone that might benefit from our channel, please forward them a note.

They subscribe on our website this week, or wherever you listen to podcasts. Apple, Google Overcast, Spotify, Stitcher. You get the picture. We are everywhere. We want to thank our channel sponsors for investing in our mission to develop the next generation of health leaders, VMware Hillrom, Starbridge Advisors, McAfee and Aruba Networks.

Thanks for listening. That's all for now.



More from YouTube