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Medicare To Require Hospitals To Post Prices Online (pbs.org)
An anonymous reader quotes a report from PBS: Medicare will require hospitals to post their standard prices online and make electronic medical records more readily available to patients, officials said Tuesday. The program is also starting a comprehensive review of how it will pay for costly new forms of immunotherapy to battle cancer. Hospitals are required to disclose prices publicly, but the latest change would put that information online in machine-readable format that can be easily processed by computers. It may still prove to be confusing to consumers, since standard rates are like list prices and don't reflect what insurers and government programs pay.
Likewise, many health care providers already make computerized records available to patients, but starting in 2021 Medicare would base part of a hospital's payments on how good a job they do. Using electronic medical records remains a cumbersome task, and the Trump administration has invited technology companies to design secure apps that would let patients access their records from all their providers instead of having to go to different portals. Seema Verma, head of the Centers for Medicare and Medicaid Services, also announced Medicare is starting a comprehensive review of how it will pay for a costly new form of immunotherapy called CAR-T. It's an expensive gene therapy that turbocharges a patient's own immune system cells to attack cancer. The cost for such a procedure can exceed $370,000 per patient.
Likewise, many health care providers already make computerized records available to patients, but starting in 2021 Medicare would base part of a hospital's payments on how good a job they do. Using electronic medical records remains a cumbersome task, and the Trump administration has invited technology companies to design secure apps that would let patients access their records from all their providers instead of having to go to different portals. Seema Verma, head of the Centers for Medicare and Medicaid Services, also announced Medicare is starting a comprehensive review of how it will pay for a costly new form of immunotherapy called CAR-T. It's an expensive gene therapy that turbocharges a patient's own immune system cells to attack cancer. The cost for such a procedure can exceed $370,000 per patient.
In reviewing insurance bills for a recent uncomplicated procedure, the hospital billed a total of $65000 and the insurance paid about $8000 after prenegotiated discounts were applied.
The insurance then ran into a technical problem/mistake in which it was retroactively cancelled. The hospital actually returned their payment. During the year it took to straighten that out, I was facing $65K in bills that they wouldn't negotiate to less than about $30K despite the existence of documentation that they had been satisfied with $8K from insurance. Needless to say, I focused on (and eventually succeeded in) reversing the insurance problem.
I've heard that the real reason for this is so they could write off $65K if a patient doesn't pay instead of $8K. I'm not an expert in the accounting, but I'm sure in my case that is what they would have been claiming as their loss.
The experience left me with a solid belief that posting prices alone would do nothing. That approach will only serve to drive more people into the wasteful net of insurance.
What is needed is a truth in pricing act. Hospitals should be required to have fixed, public, non-negotiable prices that apply to all payees whether insurance or cash. If the hospital chooses to pay some of those themselves in indigent cases, that is the price they should be allowed to write off. This approach would make some true headway in getting the insurance problem reigned in.
Posting their false prices does nothing except bolster their already drastically inflated claims of losses.