Government

CMS rules for hospital price transparency say. Have a good laugh 😷🤦🏻‍♂️

This is what the new CMS rules for hospital price transparency say:

SUMMARY: This final rule establishes requirements for hospitals operating in the United States to establish, update, and make public a list of their standard charges for the items and services that they provide. These actions are necessary to promote price transparency in health care and public access to hospital standard charges. By disclosing hospital standard charges, we believe the public (including patients, employers, clinicians, and other third parties) will have the information necessary to make more informed decisions about their care. We believe the impact of these final policies will help to increase market competition, and ultimately drive down the cost of health care services, making them more affordable for all patients.

Centers for Medicare & Medicaid Services (CMS), HHS.

This reflects the conservative/Republican view of health care cost management. It’s naive, unrealistic and fails to consider human behavior when it comes to seeking and paying for health care.

Doc, “I think we need to consider surgery, but first you should have this that and another test, I’ll make arrangements.”

Patient, “Not so fast Doc, I’ve some shopping to do. I need to go on line to see the most competitive pricing. If I go in the hospital can you tell me now all the service I will need and exactly how long I will be staying”

Doc, “Well, no I can’t because there are many variables we can’t know in advance.

Patient, “I’ll get back to you as soon as I find the most competitive prices. By the way how many hospitals do you work in?”

13 replies »

  1. Publishing the price for services provided will not solve all the problems in health care. But it will help some consumers in some situations. For instance, for those consumers who have health insurance policies with strict differences between “in-network” and “out of network” reimbursements, they will be better informed to decide which facility to go to. Maybe the “out of network” facility will be worth the difference.

    There are obvious upsides in knowing the price of hospital services. But at the moment I cannot think of any downsides.

    Like

    • The thing is, going to a hospital is typically limited by where your doctor has privileges. In addition, it’s quite difficult to determine in advance all services that will be required or even length of stay. Which would most affect a patient more their doctors recommendation or the price? This whole effort is based on the assumption that health care can be purchased like any other consumer good or service. Aside from very minor expenses like buying generic vs brand, I say thatvwill never be the case, especially when a serious and expensive illness is involved.

      Like

  2. There must be some type of transparency so we are informed of the cost of services. Recently my wife was sent home from the hospital on six weeks IV therapy that I administered. A month later CMS sent a letter telling me it was not covered. The my health plan sent a letter telling me they would not cover the cost. How much was the bill? $56,000.00.
    If I knew this at the beginning I would have question the cost to see if there was another alternative. Thank God for my pension-401K plan-and company stock that I might have to sell and pay this bill.

    Like

  3. There probably is no perfect answer but only lesser solutions…buying votes with taxpayers money has and will always been a suckers game !

    Like

  4. Gotta push back (hard) on this one too, Mr. Quinn … again, with a true story.

    I turned 65 early this year and got on Medicare, and added a Part G supplement later.
    I’ve used the Medicare card once – for a flu shot.

    Now, I’ve been getting flu shots out-of-pocket for many, many years at a little drug store in my local grocery store. I’ve never, ever paid more $35 for one, and every single time there, I’ve gotten the flu shot, plus a coupon for “10% off any grocery’s I buy, up to $200”. So, net-net, I’ve never paid more than $15 for a flu shot.

    This year, just over a month ago, armed with my shiny new Medicare card, I got a “free” flu shot – plus the coupon for “10% off any grocery’s I buy, up to $200”. So far, so good, right?

    Except that, on Monday, 4 days ago, in the mail, I received my first “Medicare Summary Notice”.
    Wherein it states that my little grocery store pharmacy billed Medicare $74.99 for my “free” flu shot (plus the aforementioned 10% off grocery coupon) – and Medicare reimbursed them exactly $71.72.

    Except we’ve already established here that it isn’t really Medicare, or the “Government” that pays for this stuff – it’s the TAXPAYERS!!!!!

    So here’s the thing, Mr. Quinn: In whipping out my shiny new Medicare card to pay for my flu shot this year, instead of just whipping out $35 worth of Federal Reserve Coupons which I also had in my wallet, I ended up bilking my fellow taxpayers out of an extra $36.72 – PLUS the aforementioned “10% off $200 worth of grocery’s”!

    So I’m not going to do that anymore – EVER, for a flu shot or anything as simple as a flu shot. NOT EVER!

    AND, you can bet your brass belly-button that I’m also going to “shop around” for any other medical services I might require, that my Medicare cards ostensibly would buy for me for “free”!

    I owe that much effort, AT LEAST, to myself, and my fellow taxpayers – both the current taxpayers AND the one’s who haven’t even been born yet! This CRAP has to STOP, Mr. Quinn! And since the “government” is the primary instigator and conspirator of this ongoing fraud, “they” aren’t going to do anything to stop it – SO I WILL!

    Now, you can call me “naive”, “unrealistic”, completely ignorant of “human behavior”, and even call me a “conservative/Republican” if you want. That’s fine. I’ll live.

    What I will not allow, though, is for you or anyone else to be able to cite ME as a “willing co-conspirator in this on-going criminal enterprise to defraud the American taxpayer”! The time grows closer for my turn to have my “chat” with my Creator. And, after 65 years of life (so far) you can bet I already have plenty of topics to “chat” about. But THIS isn’t going to be one of them!!!!!

    Like

    • Now you have price transparency. Wait until you see what is billed and allowed for physician services. You can’t look at one small example and assume it applies to all services. The person to ask is the pharmacy. Why are you bilking taxpayers, because someone else is paying the bill?

      Like

      • Nope. Nope. Nope. Mr. Quinn. This is NOT a one-off example. Nor do I “now have price transparency”. NOR is the Pharmacy the “bad guy” in this charade!

        I AM THE BAD GUY – every single time I use those Medicare cards to get “free” stuff, instead of using my Federal Reserve Coupons instead to get the exact same thing, LITERALLY CHEAPER THAN “FREE”!!!

        Look, the Pharmacy, as well as any other health care provider who/which accepts Medicare can bill Medicare (the taxpayers) whatever they wish, in order to provide me with “free” stuff. What they actually get PAID by Medicare (the taxpayers) is solely and exclusively a matter of what Medicare has already “legislated” to pay. And that’s stated on the “Medicare Summary Notice” I received, for example in this instance.

        You’ve got some 50 years experience dealing specifically with this sort of thing, Mr. Quinn, that I frankly don’t have. So I’ve got another bit of story – that you’ll probably be familiar with – and then a “hypothetical”, and then a question or two for you.

        Back in the 80’s, I was a systems engineer for a division of Bell Aerospace. And I had employer-paid health insurance. I’m also a pilot, so I had to get annual FAA flight physicals – which the health insurance didn’t cover. No problem. I found an FAA certified physician in private practice, who also didn’t accept health insurance of any kind from anyone. Again, no problem. And I decided I wanted him to also be my family physician. And on those occasions when I went to him for something NOT related to the FAA stuff, he’d just bill me, I’d pay it, and take those bills into my HR department, who submitted those bills to the company health insurance, and I was typically re-imbursed within a few days, and typically at 100% of what I’d paid. Again, no problem. That seemed to work well for all involved.

        Perhaps that scenario is/was atypical, even then. I’ll yield to your vastly greater knowledge and experience in that regard. But to me, and evidently to the insurer, that whole scheme of doing things was imminently logical and workable.

        Now for the “hypothetical” and the question[s]. Suppose, in this flu shot thing, next time I go to basically any Pharmacy and pay $35 cash out of pocket, get the receipt and submit it to Medicare for direct re-imbursement – for LESS than Medicare is willing to pay the Pharmacy directly had I used my Medicare cards to get it “free”. Do you suppose Medicare is going to actually re-imburse ME? Do you suppose they might also send me a “Thank You” for having done that, thereby saving the taxpayers $36.72? Is there any possible reason you can come up with why Medicare SHOULDN’T work that way?

        Mr. Quinn, I love you man. I come here to your blog, and read your linked articles at MarketWatch and Humble Dollar, precisely because you know more about much of this stuff than I do – so I learn things from you.

        But this post of yours struck me as being odd.

        How could someone like you, who is such a STRONG ADVOCATE and proponent of Individuals doing their “due diligence” in selecting Health INSURANCE (a policy of yours I strongly support, by the way), be so STRONGLY CONTEMPTUOUS of Individuals applying that exact same “due diligence” in selecting Health CARE? I don’t get it.

        I don’t want to press my guest privileges here any more than I already have Mr. Quinn. And I’ll apologize for the “tone” of my comments here. But I offer no apology whatsoever for the “content” of my comments.

        Like

    • You might also consider that your pharmacy can only offer those low cost shots BECAUSE they receive the higher payment from Medicare and also why does Medicare allow so much more?

      Like

      • Excellent question, Mr. Quinn – now we might be getting somewhere!

        In fact I HAVE considered that. And I have no doubt whatever that the excess Medicare prices do help subsidize the costs of flu shots! That AND a great deal more, I suspect. No argument from me whatsoever on that score.

        But can you – or anyone, for that matter – assure me that even the $35 price/net-net $15 price that I related doesn’t have enough “built-in” costs to cover it anyway?

        What in fact IS the cost/price for a flu shot? More specifically, WHY do I have to “subsidize” the costs of flu shots, solely through the Medicare bureaucracy – and thereby have to support THAT bureaucracy as well?

        Point being, your question is a good and relevant one. But it just leads to more questions. What we are needing just now are answers – and better choices, and MORE due diligence.

        Like

      • I tried to look up the actual cost of the vaccine and there great variations some based on age and type of vaccine. It ranged from about $17 to $59 with the higher cost for adults.

        Like

  5. It is a laugh. Has anyone ever paid the posted room rate on the back of a hotel room door in the states that require that to be posted? I onced stayed in a $500 night room and paid less than $100 in some chain hotel in the middle of nowhere. It was not more than a $150 room, ever.

    The difference between a hotel and a hospital is that hotels charge by the availability of the rooms. The higher the expected bookings for a giving night the higher the rate. Think NYE on Times Square.

    Hospitals charge according to the ability to pay. Those who can afford to pay because of insurance usually get charged less than those who can’t pay. I believe this is because they charge the uninsured the “posted room rate on the door” so that they can claim that they gave the insurance company a discount and that they have much bigger loses from those who don’t pay. I just wish that everybody got charged exactly the same for the exact same service, treatment, or drug. My insurance pays out between 15 to 80% of the billed priced submitted. The uninsured should get the same rate if a provider is willing to accept only 20% of the bill.

    This rule will do nothing.

    Like

What's your opinion on this post? Readers would like your point of view.

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s