The federal government’s next action to improve price transparency among providers may be requiring organizations to publicize the contracted prices they charge insurance companies for services.
A request for comment on this idea and other price transparency initiatives was slipped into a proposal to prevent health information blocking released in February by the Office of the National Coordinator for Health Information Technology. It was first noticed by the Wall Street Journal a month later.
The request for comment comes after a section of the proposal in which the ONC recommends a new definition of “electronic health information”—one of the subjects of the rule—that includes price information. The agency specifically proposes that EHI encompass any information related to “the past, present, or future payment for the provision of health care to an individual.”
With this definition in mind, the agency then seeks public input on a variety of questions related to what types of price information should be unblocked, and how the healthcare industry could go about improving access. In addition to considering contracted rates, other ideas the ONC floated include requiring organizations to provide a “binding” price quote prior to service and sending a single billing statement for all of a patient’s services to reduce surprise bills.
The following is an excerpt of the ONC’s request for comment that contains the question about publicizing negotiated rates:
Increased consumer demand, aligned incentives, more accessible and digestible information, and the evolution of price transparency tools are critical components to moving to a health care system that pays for value. However, the complex and decentralized nature of how price information is created, structured, formatted, and stored presents many challenges to achieving price transparency. To this point, pricing within health care demands a market-based approach whereby, for example, platforms are created that utilize raw data to provide consumers with digestible price information through their preferred medium.
ONC has a unique role in setting the stage for such future actions by establishing the framework to prevent the blocking of price information. Given that price information impacts the ability of patients to shop for and make decisions about their care, we seek comment on the parameters and implications of including price information within the scope of EHI for purposes of information blocking. In addition, the overall Department seeks comment on the technical, operational, legal, cultural, environmental and other challenges to creating price transparency within health care. Should prices that are included in EHI:
- Reflect the amount to be charged to and paid for by the patient’s health plan (if the patient is insured) and the amount to be charged to and collected from the patient (as permitted by the provider’s agreement with the patient’s health plan), including for drugs or medical devices;
- Include various pricing information such as charge master price, negotiated prices, pricing based on CPT codes or DRGs, bundled prices, and price to payer;
- Be reasonably available in advance and at the point of sale;
- Reflect all out-of-pocket costs such as deductibles, copayments and coinsurance (for insured patients); and/or
- Include a reference price as a comparison tool such as the Medicare rate and, if so, what is the most meaningful reference?
After the Wall Street Journal article was published, numerous U.S. residents commented in favor of the price transparency ideas contained in the proposal. No provider organizations have yet weighed in.
Providers can submit responses to the request for comment here. The comment period ends May 3.
Another effort is ongoing in the U.S. House of Representatives to require providers to publicize more accurate pricing information for patients, which may involve contracted rates. A bipartisan group of legislators introduced H.R. 1409 in late February, which would require hospitals, payers, pharmaceutical manufacturers, and other industry players to publicize “wholesale, retail, subsidized, discounted, or other such prices” that they charge. No definition of “discounted” is provided, but the term could be interpreted as prices that hospitals negotiate with payers.
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