The push for health care pricing transparency has been gaining steam for the past couple of years. Progress has so far been measured in inches rather than miles, but this may change if the Trump administration has a say. The President is expected to release an executive order addressing health care pricing transparency which, if enacted, would require health care organizations to disclose pricing information to patients and employers, enabling them to view negotiated rates between insurance providers, hospitals, and doctors.
Challenges in Enforcing Price Transparency
This isn’t the administration’s first foray into improving health care pricing transparency. The President signed two bills into law in 2018, the Know the Lowest Price Act and the Patients’ Right to Know Drug Prices Act. These bills eliminated pharmacy gag clauses that prohibited pharmacists from letting consumers know if they could save money by paying for their prescriptions out-of-pocket rather than relying on their insurance company. And the Department of Health and Human Services announced just this month that prescription drug ads airing on television will be required to include pricing.
While these are good starts, there is still much work to be done to ensure prescription drug price transparency. The prescription drug rebate system, for one, could use a complete overhaul. And drug price transparency in and of itself isn’t enough to effect change in the competitive marketplace; consumers would benefit from additional information, such as knowing which medications are most effective for certain conditions. Key players such as MedSavvy are making an effort to tackle this problem, and the federal government is supporting a number of initiatives that would publicize information for consumers.
Another goal of the Trump administration is to provide information on the quality of physician practices serving Medicare beneficiaries. A website called Physician Compare has been set up by the Centers for Medicare and Medicaid Services, and while it’s a step in the right direction, only about 20 percent of physicians are currently listed in the database and, because reporting is voluntary, the site doesn’t paint a full picture.
The government began requiring all hospitals in the U.S. to post price lists for their services and products online starting January 1. However, this law has yet to be enforced – and given the propensity for using acronyms, abbreviations, billing codes, and medical jargon, there is debate over whether these price lists are helping patients or confusing them.
Despite these challenges, the administration is moving full speed ahead to continue to implement changes in order to make the patient experience a more positive one. The end goal is to convince consumers that it’s worthwhile to comparison shop for health care services, something they have traditionally resisted.