Course | Overview | Transparency

This course addresses the HFMA Healthcare Dollars and Sense initiative and its impact on revenue cycle operations.

Course | Overview | Transparency

This course addresses the principles of price transparency, the role of price estimates in patient financial care and how pricing information is used to prepare and present price estimates.

News | Transparency

Amid Clashes, Senators See Bipartisanship on Transparency

News | Transparency

Amid Clashes, Senators See Bipartisanship on Transparency

June 20—Members of Congress remain deeply divided over health insurance approaches but see a path to bipartisan agreement on transparency.

Although the various provisions of the transparency bill are not yet finalized, the senators have received 800 pages of feedback from industry stakeholders—including hospital advocates.

June 20—Members of Congress remain deeply divided over health insurance approaches but see a path to bipartisan agreement on transparency.

Sens. Bill Cassidy (R-La.) and Michael Bennet (D-Colo.) remain deeply dived on whether to alter the Affordable Care Act (ACA) by expanding the government’s role in insurance coverage or by minimizing it. Bennet introduced legislation in 2017 to create “Medicare-X,” a public insurance option based on Medicare. Meanwhile, Cassidy plans to again push legislation this year to repeal and replace the ACA with a more state-led approach.

Both efforts aimed to make healthcare coverage more affordable to more Americans, but each was rejected by the other bill’s sponsor as worsening the problem.

“Medicare for all will be Medicare for none,” Cassidy said June 20 at a Washington Post health forum. “Medicare, which is going bankrupt in eight years, according to the actuaries, will suddenly have an influx of more expensive patients.”

Bennet countered that Cassidy’s repeal-and-replace bill would reduce Medicaid funding and cause rural hospitals in his state to go out of business.

Transparency Agreement

An approach that both senators agree could increase the affordability of health care is to greatly expand transparency.

“A big part of problem is that for too many parts of the system, opacity has become a business model and the result is that nobody knows what anything costs,” Bennet said. “There you don’t have to have an argument between Republicans and Democrats about what the role of government should or shouldn’t be.”

Both senators are part of a bipartisan six-senator group in discussions to write a wide-ranging healthcare transparency bill.

“One thing we are absolutely in agreement on is the need to lower healthcare costs,” Cassidy said. “It’s important for the people sitting around the family kitchen table, it’s important for state governments who’ve expanded Medicaid and now Medicaid is cannibalizing their budgets, and it’s important for the Medicare trust fund,” Cassidy said.

Although the various provisions of the transparency bill are not yet finalized, Cassidy said he has received 800 pages of feedback from industry stakeholders. In comments submitted to the senators in the spring, hospital advocates outlined measures they would support but also urged caution in pursuing new federal requirements.

Among specific provisions Cassidy would like to include is a requirement that insurance companies eliminate so-called gag clauses that bar pharmacists from telling insured customers about ways to save money by paying cash for some drugs. The Trump administration recently wrote insurers urging—but not requiring—the elimination of gag clauses.

“It focuses our attention where it should be focused: How we can create a healthcare system that actually works for the American people, because the one we have right now is not working well enough,” Cassidy said.

Overall, Cassidy said he’d like the bill to reduce both the cost of insurance and the costs for specific procedures.

That legislation would follow previous Trump administration transparency initiatives. For instance, hospitals would be required to post their “standard charges” online by FY19 under Medicare rules proposed in April.

“That’s just the tip of the iceberg of where we need to and will go, in terms of mandating requirements around price and quality transparency for patients,” Alex Azar II, secretary of the Department of Health and Human Services, said at the forum.

Also on June 20, the administration put out a request for information on ways to change Stark and anti-kickback laws to eliminate restrictions that prevent integrated care. Existing interpretations of those laws incentivize common ownership, Azar said.

“And I’m not sure that bigger is always better, as opposed to collaboration that can be done virtually,” Azar said. “I’d like to make sure that we are agnostic to ownership structures; let economics drive that, not our payment systems or regulatory environment.”

Other possible bipartisan healthcare legislation may allow states to combine the individual-market and Medicaid populations into a single risk pool. The provision, which was included in the so-called Graham-Cassidy bill that was narrowly rejected in 2017 by the Senate, would lower healthcare costs by 20 percent by reducing the uncertainty of smaller risk pools, Cassidy said. 

Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

About the Authors

Rich Daly
HFMA senior writer/editor


Related Articles | Transparency

Blog | Transparency

Analysis: Proposed negotiated-rate posting requirements from the OPPS rule

HFMA's Chad Mulvany offers insight into the major issues associated with CMS’s proposed new requirement for hospitals to post negotiated rates.

Fact Sheet | Pricing

Negotiated Rate Posting Requirement Under the CY 2020 OPPS Proposed Rule: HFMA Summary

This HFMA summary explains the negotiated rate posting requirement under the CMS CY 2020 OPPS proposed rule.

News | Medicare Payment and Reimbursement

A look at early hospital concerns over the proposed release of negotiated charges

National hospital advocates, individual executives and an industry adviser identified early concerns with the proposed mandatory release of hospital-negotiated charges.

News | Medicare Payment and Reimbursement

OPPS rule to bring many hospital financial challenges — and a little help

The long-awaited Medicare proposed rule for hospital outpatient payments includes a high-profile mandate on hospitals to release rates negotiated with commercial health plans, among other regulations that could pose financial challenges. Several smaller provisions could help hospitals.