Only in health care do Americans routinely purchase services and then learn about the price weeks or months later. For too many Americans, opening a medical bill is a moment of trepidation.
At the Quality Institute, we’ve supported transparency from our earliest days — in quality and in cost. So we support the parts of President Trump’s Executive Order that direct national agencies to create rules that increase transparency around health care prices.
As federal agencies develop these rules, we want to start a dialogue with you, our members, about what’s most important to consumers and employers as we fundamentally change what consumers can learn about the price of their health care. I am eager for your insight and perspective.
I’m also sharing Five Key Principles that we believe federal agencies should follow as they consider how to move forward with this ambitious policy change — one that has the potential to help us control our ever-increasing health care spending.
Providing price information alone is not enough. Patients overwhelmingly trust the advice of their physicians about what care they need and where to get it. Any effort to change consumer decision-making will succeed only if consumers are given evidence based information about the benefit of a particular service, such as from the Choosing Wisely Campaign, and given understandable information on quality and safety indicators from a nationally recognized organization such as The Leapfrog Group.
Meaningful Consumer Protections
Prices that are outdated, are overall averages, or are shared when a patient is in a crisis will not help consumers or change behavior. Often protections beyond transparency and disclosure are needed to address health care pricing and spending. It is important to understand both the value and the limits of transparency and put in place additional consumer protections, such as bans on balance billing for surprise bills and arbitration options to address outlandish bills.
Patients need to know what providers are in their insurer’s network, the price their insurer negotiated with that provider, and what their own out-of-pocket costs will be at any given time. Only insurers can accurately provide that information. That is a service that insurers should be held accountable for providing to their customers. Any rule should recognize who has this information and how it should be shared with consumers in order to be effective.
Prix fixe, not a la carte
Consumers should not have to put together all the elements of their procedure to determine the final cost. Instead, the bundled price of the procedure — say a hip or knee replacement — should be provided and should include the cost of the surgeon, the anesthesiologist, rehabilitation, medicines, and other costs.
Technology and tools
We’ll need the right technology and tools so consumers can easily access information to compare prices and quality. The government, as the largest purchaser of health care, should invest in these tools.
Transparency has always led to increased safety and better quality. We believe that transparency, in concert with strong consumer protections and technology tools, will help address our national health care spending problem. Rising health costs are prompting small businesses to drop health insurance for their employees and eroding salaries. They’re devastating government budgets.
The power of consumers can make a difference, but only if consumers have the information they need to make informed decisions.