Hospitals in the USA required to publish prices

 

The order directs The US Department of Health and Human Services (HHS) to develop a rule to require hospitals to disclose prices that reflect what insurers and patients pay for common items and services.

The new order does not specify what level of detail hospitals must provide on the privately negotiated rates between hospitals and insurers for specific health insurance plans or aggregate data. Those particulars will be included in the forthcoming rule.

Hospitals will be required to make public information based on their negotiated rates with insurers and both providers and payers will be ordered to give patients estimates for out-of-pockets costs for procedures in advance.

The move will almost certainly be met with backlash from the healthcare industry. The order is likely to face a legal challenge, which could at least delay implementation.

From 2019, the Centres for Medicare and Medicaid Services (CMMS) require hospitals to post standard charges online in a machine-readable format, though even CMMS accepts it has no real way to enforce the requirement and many hospitals are not complying.

Patients face wide variations in prices, often for the same services, due to a lack of transparency. Publicising the true prices of healthcare services will allow Americans to make choices that fit their personal healthcare needs and financial situations.

Little will change right away. The executive order calls for a rule-making process by federal agencies, which typically takes months or even years.

The details of what information will have to be disclosed and how it will be made available to patients must be worked out as part of writing the regulations. That will involve a complex give-and-take with hospitals, insurers and others affected.

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