news Congress turns to hospital pricing transparency

All of the House Speaker’s confusion aside, members have quietly expressed interest in revisiting hospital pricing transparency requirements. This is a seemingly harmless policy initiative that has historically attracted fierce industry opposition.

Important reasons: There is a great deal of debate about whether price transparency itself will lead to lower healthcare costs, or whether it is the first step toward stronger reform.

  • Hospitals argue that publishing negotiated rates actually has an anti-competitive effect.

Big picture: Many experts complain that hospitals are complying with the law, arguing that the penalties are too small to pay off. characterizes it as being very good, and actually says it’s pretty good.)

What we see: E&C Chair Cathy McMorris Rodgers and former Chair (now a key member) Frank Pallone are unhappy with the compliance, and aides say the agenda is ripe for action in Congress now. .

  • In a November letter to the GAO, Pallone and McMorris-Rogers said they were “concerned by continued reports of poor hospital compliance and a complete lack of compliance in some hospitals.” and called for an investigation into compliance with the regulations.
  • “We are also plagued by reports that some hospitals disclose their prices, making it difficult for consumers to access pricing information.”

By numbers: According to CMS, as of November, only two hospitals had fined them for not complying with transparency requirements, but had issued more than 400 warning notices and implemented more than 200 remediation plans. I requested.

  • With the exception of the two hospitals that were fined, “all other hospitals that have undergone compliance reviews have resolved their deficiencies or are in the process of doing so. We didn’t have to,” an agency spokesperson told Axios.
  • CMS has already increased the penalty amount once.

What they say: Making the violation more painful is definitely on members’ radar, a Republican aide familiar with the debate told Axios.

  • “I think we’re very open to increasing that enforcement mechanism,” the aide said.
  • That doesn’t necessarily mean higher fines. “Civil fines may not be the best way to increase compliance,” he added.
  • An E&C Republican aide said the commission conducted an oversight of compliance with the rules in the last Congress.

Opposite side: Among other arguments against the policy, hospitals say the rules are difficult to follow, plus they’re too overwhelmed by the pandemic to fully comply.

  • The requirement to provide negotiated rates “continues to pose challenges in terms of cost and complexity,” the AHA wrote in a blog post last summer.

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