The order will direct federal agencies to initiate regulations and guidance that could require insurers, doctors, hospitals and others in the industry to provide information about the negotiated and often discounted cost of care
Here at SurgeryShopper.com we’ve been expecting someone to do this for years. We are at a loss to explain why there’s so much resistance.
Industry groups including many hospitals and insurers balk at the idea, saying it could cause costs to climb if some payor organizations learn competitors are getting bigger discounts. We understand this and that’s why you don’t see prices for procedures associated with the facilities online. We hold those prices offline in our database and a concierge coordinator reveals the prices to our clients and visitors. We make it impossible for competing HMOs and PPOs to skim our site and target our participating providers.
We spoke with Maria Todd of AskMariaTodd™, an expert with more than 3 decades of contracting with employers and health, travel assistance and workers comp insurers for bundled price surgeries around the USA and abroad. She explained that the providers have been pressured to sign contain all kinds of provisions that turn this fear into threat for many hospitals, surgeons, and ASCs. She says that “consumers are more interested in the amount they will be responsible for out of pocket. Employers want predictability and reasonableness, not “cheapest”. They are willing to pay what’s reasonable and necessary to assure quality and safety. The way these transparency laws are being enacted, consumers and self-funded employers won’t benefit from full disclosure of negotiated prices for line item charges. Consumers simply don’t know enough to take that “data” and convert it to useful “information”. We don’t need more government regulation, we need “real, informative” transparency.”
“Imagine if you went to the grocery story and instead of paying for one complete, finished loaf of bread, you got a bill for each pinch of salt, cup of flour, fraction of an ounce of seasoning, ounces of proteins, and more, with an embedded and opaque markup to cover the cost of managed care contracts analysis and negotiations, broker and producer commissions and fees, TPA and PBM kickbacks in cash and in kind, and more.” It becomes very difficult if not impossible to see what the price of the finished product is (in this case a surgery procedure). There’s little transparency on what happens when the hospital or ASC submits a bill to an ASO or TPA. What the hospital sends in is an artificially manipulated price because of Medicare regulations and how health plans draft their provider contracts.” So in short, according to Todd, the requirement to list line item prices will add administrative cost to the healthcare system in America but there won’t be any real value produced by the requirement.
SurgeryShopper.com will continue to grow its participating provider and pricing database and provide value to consumers and employers by leading the way to discover inpatient and outpatient surgical packages that include:
- physician consultation
- pre-admission case management care continuity conference
- facility fees
- anesthesia fees
- implant, prosthetic and hardware costs
- any overnight stay in the facility
- discharge management visits
- post-operative case management care continuity conferences, and
- estimates of travel and accommodation and ground support costs for patients who must travel to access care. ♦