The Trump Administration and its healthcare regulators are feeling out a proposal to force hospitals and health plans to publicize the prices negotiated between the groups for healthcare services and products.
Rate negotiations between payer and providers on prices are generally secret – much of the time by contract – leaving patients in the dark about the true cost of their care.
Creating a rule requiring these organizations to publicize the results of these arrangements would put more power in patients’ hand and push the healthcare industry towards being more consumer friendly, a leading priority of the Trump Administration.
More transparency about cost and prices – the theory goes – would empower patients while also putting more downward competitive pressure on healthcare organizations.
The idea was telegraphed in a request for comment tucked into the recently released ONC proposed rules for supporting interoperability and giving patients control of their own data.
“Consistent with its statutory authority, the Department is considering
subsequent rulemaking to expand access to price information for the public, prospective patients, plan sponsors, and health care providers,” the ONC rule states.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
The Wall Street Journal was the first to report on the request for information. A final rule that includes the price disclosure requirement will be released after the comment period ends May 3.
If this provision is included, industry lobbying groups like the American Hospital Association and American Medical Association are nearly certain to mount legal challenges and its unclear what effect the move would actually have to move prices.
The Trump administration has pitched the idea of the consumer at the middle of the health purchasing experience, a major component of which is greater transparency in healthcare cost and quality.
Earlier this year a new CMS rule went into effect requiring hospitals to publically post their chargemaster prices, which administration officials described as a “first step” toward price transparency.
One deficiency in that initiative has been the lack of enforcement muscle behind it and many hospitals have been found failing to publish their prices or using forms basically unreadable by the average patient. In contrast, the ONC rule would also come with potential financial penalties for noncompliance.
In another similar effort, the Trump Administration has weighed forcing drug manufacturers to disclose pricing information in their direct-to-consumer ads.
Photo: JamesBrey, Getty Images
