By Leslie Small
The Trump administration
on July 29 issued a proposed rule that would require hospitals to publicly
disclose payer-specific negotiated rates for all "items and services"
they offer, such as procedures, supplies and facilities fees.
One expert tells AIS Health
that a legal challenge from industry groups is all but certain if the rule is
finalized.
"They will
undoubtedly get sued, and probably sooner rather than later," says Dan
Mendelson, founder of the consulting firm Avalere Health, says of the
administration. The statute that CMS drawing upon with its proposal allows HHS
to require that hospitals disclose their "usual rates," he says, but
doesn't allow the agency to compel the disclosure of rates negotiated with
insurers.
America's Health
Insurance Plans (AHIP), meanwhile, argued that revealing negotiated rates would
cause providers to push prices higher.
Citing a 2015 blog post
from Federal Trade Commission officials that makes a similar point, AHIP
President and CEO Matt Eyles said in a statement that "multiple
experts…agree that disclosing privately negotiated rates will make it harder to
bargain for lower rates, creating a floor — not a ceiling — for the prices that
hospitals would be willing to accept."
In general, though,
"the administration's instinct, I think, is absolutely right — that
consumers want this kind of information; they want cost information, and they
want quality information," Mendelson says.
Ben Isgur, the leader of
PwC's Health Research Institute, points out that "there's another group out
there that’s very interested in prices — and those are the employers." If
they had access to negotiated rates for hospital services, employers would have
an easier time choosing lower-cost providers when setting up their health
plans’ networks, he says.
From Health Plan Weekly
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