PPA is encouraging that physicians and others comment to Health and Human Services regarding the Trump Administrations’ most recent Price transparency rule found here.
This proposed rule complements a previous rule requiring hospitals to post their actual prices online and requiring insurers to disclose (in easy-to-understand format) the prices they now negotiate in secret with hospitals and other providers. The effect would be to enable patients to have some idea before they receive care of what they could end up owing to a provider after the care is delivered and the insurer has issued an Explanation of Benefits (EOB) showing what portion of the cost has been covered. This is a step toward pricing sanity in a more-competitive healthcare marketplace because it supports informed shopping by consumers of medical services. The intent is to enlist and boost the power of consumers in driving down prices.
It is crucial for physicians and patients to comment, as the insurance and hospital industry have come out in full force supporting the now hidden prices that have allowed these two industries to profit themselves while gouging Americans. This is especially true of the most consolidated hospital systems and dominant insurance companies who use opacity combined with their respective market shares to continually drive prices up. They simply have no incentive to lower prices.
PPA’s full comments are below. You are welcome to copy and paste them in part or whole. When commenting, adding your personal story regarding how patients are hurt by opaque prices.
For ease, you can consider copying and pasting a personalized form of these italicized comments: I firmly support the current efforts to bring the prices of medical services and procedures into the open and to make those prices easily accessible to our patients—in short, to replace price opacity with price transparency.
Noting that in the proposed rule, HHS also requested comments regarding how to enact transparency of quality, I request transparency in the level of the training attained by those who deliver care, and full disclosure of conflicts of interests of any person or organization the government relies on to define or implement quality in health care.
SUBJECT: CMS-9915-P, Comment on the Proposed Rule Mandating Price Transparency
Ending price OPACITY in favor of price TRANSPARENCY is critical to driving down the costs of all forms of medical care in America.
Practicing Physicians of America (PPA)—a non-profit organization representing thousands of physicians, and a part of the Free-to-Care Coalition, now comprised of 37,000 physicians and 3 million citizens—declare their firm support for the proposed rule requiring insurers to reveal the prices they negotiate with all providers of medical care.
Why Transparency is So Sorely Needed
Each day, the thousands of physicians represented by PPA see the pain in the pocketbook of our patients. We see their foremost concern when they seek medical care. What will this cost?
We have observed our patients incurring higher out-of-pocket costs for health insurance (which ought NEVER to be confused with actual healthcare) that outpace their wage increases and threaten the financial viability of their households.
More than ever before, the patients we treat in our offices are looking for an accessible, easy-to-understand way to shop for the medical services they need and to control their medical expenses. They would like also to see the exposure and defeat of the hidden forces that drive the relentless rise in premiums in response to excessive costs routinely obscured under the third-party payer system that has dominated American healthcare for close to 50 years and been an engine of our stratospheric rates of inflation in the cost of healthcare.
Price opacity, which has enabled forms of price gouging, has produced the environment we see today in which one in five Americans have had medical bills turned over to collection agencies.
This country desperately needs informed consumers of medical services who have choices at their disposal. Price opacity abets ignorance. Price transparency would vindicate the axiom of Francis Bacon: Nam et ipsa scientia potestas est. (Knowledge is power.) The informed consumer who is capable of making choices in a free marketplace that has been disciplined by competition is the only reliable force for driving down deductibles, premiums, and other costs.
Do the lobbyists of the health insurance and corporate hospital industries resist calls for the end of opacity and the introduction of transparency? Of course they do. They’ll move heaven and earth to keep the good thing going that has fattened their coffers at the expense of the American patient. Those administrator-heavy industries drive inflation in healthcare by every means our current system has legitimized.
Consider the following.
For certain services and procedures provided on an inpatient basis, hospital charges grew by 42% over the eight-year period from 2007 to 2014.
Similarly, for hospital-based, outpatient care involving the same services and procedures, charges increased by 25%.
The charges for the same services and procedures provided by independent physicians grew by only 6% over the same eight-year period.
Those figures are drawn from a study of insurance claims data by the Health Care Cost Institute that has been the subject of reports in the last year.
Meanwhile, as the resources of the American consumer of medical care are relentlessly squeezed, the profitability of the health insurance industry is a picture of robust financial health.
The health insurance and corporate hospital industries benefit from the price opacity that has become the sine qua non of the wildly inflationary, third-party payer system that has dominated the landscape of American healthcare for a half-century.
This scandalous gravy train operating under cover of law and public policy must be halted. Transparency is the brake to do the job.
Those who enact national policy via regulation need to think FIRST of the needs of American patients and to tell the lobbyists of the health insurance and corporate hospital industries that they will no longer be permitted to be the dominating, decisive voices in the room.
On Quality
In inviting comment, the Departments have raised also the question of how Americans can shop on an informed basis for medical care of high quality that is affordable.
Yes, quality can be hard to define and quantify… although most people recognize it when they see it and can distinguish differences in quality when they experience them.
PPA offers this counsel. If the Departments are contemplating a forum of stakeholders to explore the question of quality in healthcare, it would be essential that any such forum be composed of the full range of stakeholders, most heavily represented by patients and the physicians who deal with them directly and personally.
When it comes to physicians, a “quality forum” should include not only physicians employed by corporations but also independent physicians.
When it comes to hospitals, a “quality forum” should include not only the urban, the regional, the large, and the corporate, but also the smaller, the rural, and the independent.
In addition, the representatives of stakeholders participating in any such forum on quality must be required to declare the interests they represent. The interest of the wider public, American patients—who seek to maintain their choices while simultaneously looking for relief from the high costs related to the medical care they receive and the insurance they carry as a hedge against catastrophic costs— must be protected from the special and narrow interests that have greatly profited under the current inflationary, increasingly consolidated, increasingly corporatized system that has sprung up and flourished under a system of opacity.
“Quality” as a Function of the Practitioner’s Training
As shown by surveys over the last decade, one measure for enhancing patients’ recognition of quality would be mandating transparency regarding the level of training acquired by medical practitioners. As the numbers of nurse practitioners and physician’s assistants have grown over a period that has seen some states allow nurse practitioners to “practice” as the functional equivalent of physicians, patients have experienced increasing confusion over who is delivering their care.
There is a vast gulf between the minimum 15,000 hours of clinical experience needed to become a physician and the 500 or 1,000 clinical shadowing hours needed to qualify as a nurse practitioner, or the 2,000 clinical hours required of a physician’s assistant. Given the obvious disparity in-depth and quality of training for these levels of medical practitioner, patients deserve to know the degree of training experienced by their caregivers, and they deserve the freedom to seek care from practitioners of their choosing.
Requiring hospitals and clinics to post prominently the levels of training of all practitioners is a simple step toward transparency. It will minimize confusion and strengthen the ability of the American patient to identify quality.
Conclusion
Regarding Transparency. PPA firmly supports the current efforts to bring the prices of medical services and procedures into the open and to make those prices easily accessible to our patients—in short, to replace price opacity with price transparency.
Regarding Quality. We counsel that the Departments, in addressing the question of quality, whether by a forum or some other means, seek input from a range of stakeholders, and most particularly from patients and physicians. The Departments must be acutely conscious of the interests and agendas that inform what stakeholders have to say. The Departments should also never lose sight of the inescapable reality that any regulatory mandates on information-gathering that can be predicted to add to the administrative overhead already encumbering the practice of medicine in the United States will be at odds with efforts to create a freer, more-competitive marketplace in which prices can be first be expected to stop rising, and then proceed to fall.
Lastly, PPA calls for transparency in the level of the training attained by those who deliver care.
