Today, FAH submitted a letter in response to a request from Senators Cassidy, Bennet, Grassley, Carper, Young, and McCaskill. The Senators recently launched a bipartisan effort to increase health care price and information transparency to empower patients, improve quality, and lower costs. The letter notes FAH members’ support of efforts to promote transparency and provide information to enhance consumer choice and offered principles for Congress to consider regarding the release of such information. This information is not only important for consumers prior to receiving medical services, but also is important when they are selecting their health insurance coverage; and it should be clear, accessible, and actionable and focus on what patients want and need to know – their out-of-pocket costs and their provider networks. It should also be coupled with quality information so consumers can make informed decisions based on both the cost and quality of care. The letter makes numerous recommendations for improving quality measurement and public reporting, including with regard to the Star Ratings Program and the use of electronic health records (EHRs).
For insured patients, insurers are in the best position to provide pricing information to their enrollees as they have access to information about the entire episode of care. Additionally, FAH recommends adoption of the “surprise billing” section of the National Association of Insurance Commissioners’ (NAIC) Model Act. The NAIC model protects insured patients from surprise bills when they receive services in an in-network hospital but some of those services are delivered by an out-of-network physician. For uninsured consumers, health care providers and state databases are sources of pricing information, recognizing that there are limitations to this information due to the involvement of multiple providers in an episode of care and the uniqueness of each patient. The letter also cautions against the release of negotiated rates between insurers and providers, as such information is not useful or actionable for patients and could have anticompetitive effects.
Lastly, the letter notes the extraordinary number of regulatory requirements with which hospitals must comply and recommends actions Congress and the Administration could take to lessen these requirements and improve health outcomes and efficiencies.
You can find a complete copy of the letter here.