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"Health care is the only industry where a consumer does not find out the cost of a product or service until after they have purchased it. That needs to change."

Imagine going into a restaurant and seeing every item on the menu listed as “Market Price.”  You ask what that price is, but the server can’t tell you.  Now imagine that every restaurant in town has all their items listed as “Market Price”.  How could you possibly decide what to order and where?

That is the exactly the situation Americans find themselves in when they need hospital or other medical care.  The same test or procedure at two different facilities can have radically different prices, often thousands of dollars apart, and the patient has no way of knowing.

 

Health care is the only industry where this lack of price transparency exists.  With more and more Americans on high-deductible health plans, and a growing number unemployed and therefore uninsured as a result of the pandemic, many Americans are footing the full bill for their health care. Because patients don’t know what the price of care is until after they get their bill, they can’t negotiate or even shop for price.  Many are receiving bills they could not have foreseen, let alone afford.

As an independent rheumatologist, I have seen many patients forced to make choices that compromise their care because they don’t know what the care will cost.  They simply cannot afford to take the financial risk.  According to CarePayment, a patient financing company that helps people manage their medical expenses, 64% of patients have avoided or delayed medical care in the last year due to costs.

A poll in July, 2021 by Patient Rights Advocate, a non-profit, non-partisan consumer advocacy group, found that 87% of patients want price transparency in health care. Despite today’s political polarization, this is truly a bipartisan issue.  When asked whether health-care organizations (insurance companies, hospitals and doctors) should disclose their prices, both the cash prices that those without insurance pay, and the contracted rates providers negotiate with insurance plans, 90% of Republicans and 85% of Democrats said yes.  Furthermore, 87% of those who supported President Trump and 88% of those who didn’t, also favored increased transparency.

 

Imagine going into a restaurant and seeing every item on the menu listed as “Market Price.”

 

Fortunately, the federal government finally addressed this problem by issuing The Hospital Price Transparency Rule, which went into effect Jan. 1, 2021. This rule requires each hospital operating in the United States to provide clear, accessible pricing information online about the items and services they provide. The problem is that many hospitals are not complying. A report released last month by a national nonprofit organization showed that the vast majority (94.4%) of hospitals, were not following the rule by

I have written to Pennsylvania Attorney General Josh Shapiro asking him to help enforce the law and hold hospitals accountable.  To do that, our government needs to dramatically increase the financial penalties imposed on hospitals that don’t follow the rule. Currently, the penalty is only $300 a day.  That is woefully inadequate.  Worse, the government has yet to fine a single hospital for not complying with the government’s own rule.  What good is a law with no teeth?  The fine needs to be increased significantly and robustly enforced.  We should also eliminate the loophole in the rule that allows hospitals to simply provide estimates, not guaranteed prices

Transparent health-care prices would lead to increased price competition and lower costs for patients.  Innovations in health care would be rewarded and surprise billing would be reduced.  When consumers can shop for health care by comparing prices, they will not only be in better control of their health-care expenditures, but they will also be able to avoid getting surprise medical bills.

 

We have a long way to go to fix our broken health-care system. Any potential solution must include price transparency as an essential component. The right to know the cost of care before getting a surprise bill is critical.  This only changes if a significant percentage of physicians and patients apply pressure to our elected leaders.  We should demand nothing less.

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Mark Lopatin

Rheumatologist, author, trustee for the Pennsylvania Medical Society Board of Directors, health care advocate

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