medical treatment bill, calculator and phonendoscope on blue desk background; blog: price transparency in healthcareAs we’ve talked about in our previous blogs on value-based healthcare and accountable care organizations, healthcare as an industry is facing big changes. To complete our trilogy on how the business of healthcare is changing for providers and patients, we are going to look at price transparency in healthcare. This is an issue that came to the forefront of the healthcare discussion last year when President Trump issued an executive order on transparency in healthcare price and quality. 

The Executive Order

In 2019, President Trump issued an executive order calling for increased price transparency in health care. The Department of Health and Human Services, Department of Labor, and Department of the Treasury have issued proposed rules they’re calling “Transparency in Coverage” in response to the executive order. 

The goal of this executive order and the proposed rule is to allow patients to make more informed decisions about their own care. If the order is enacted, consumers will know about the cost of services before committing to a treatment plan. The rules may also allow patients to know more about the quality of care they can expect from providers and organizations.

Actual Prices

Part of the order requires providers and insurers to disclose the “actual” prices of services patients. In this case, the actual price is the rate negotiated between the insurance company and the healthcare provider. These rates can vary greatly from the prices patients without insurance pay out-of-pocket for the same services.

It’s important to note that actual prices only reflect the negotiated rates between providers and insurers. Consumers may be able to find out how much of the cost insurance will cover. However, if the order becomes policy as it is now, price transparency would not automatically extend to letting patients know more about out-of-pocket costs without insurance.

HHS Quality Summit

The U.S. Department of Health and Human Services (HHS) is undertaking a review of the healthcare system with the goal of implementing these rules. It is called the Quality Summit and will bring together experts in the health industry and lawmakers to see how things can be improved. According to HHS, it includes 15 non-government healthcare industry leaders that can help the HHS become more efficient and modern. The discussions will take a patient-centered approach to ensure that any changes made will have a positive impact on consumers.

Possible Pros and Cons

Some critics say that this will create confusion for consumers looking for information on how much a medical service will cost them personally. Other critics say that such a policy will hurt the advancement of value-based care models because there might still be a focus on fee-for-service. Some hospitals and care organizations are planning to fight the new rules, but it remains to be seen what will happen.

However, many are praising the rules and think there will be many benefits to price transparency in healthcare. They believe that having healthcare costs be public can only lead to good things. Patients may be able to “shop” for a better deal with a different provider. That could lead to more competitive pricing. Price transparency may also lead to a reduction in patients getting unnecessary services and procedures, which will also result in lower costs all around.

The surgeons and associates at South Shore Orthopedics provide individualized services so that care is accessible to everyone. We want to make sure you get the care you need when you need it. If you have concerns about your joint health or an injury, call our office at (781) 337-5555 to make an appointment