Health industry speaks out against CMS transparency rule
Many in the health industry worry the rule would cause more harm than good, and just add to consumers' confusion.
In a move hailed as a major win for health care price transparency, the Centers for Medicare and Medicaid announced last year that as of January 1, 2021, hospitals would be required to post negotiated rates for common medical procedures.
Many in the health industry worry the rule would cause more harm than good, and just add to the current confusion surrounding our complex health care billing system.
Related: How will the CMS’s new health care price transparency rule play out?
“Forced disclosure of privately and competitively negotiated rates, as proposed in this rule, will not provide information that is actionable by, or helpful to, consumers and exceeds the departments’ statutory authority,” insurer lobbying group America’s Health Insurance Plans said in a written comment to the CMS.
Instead, AHIP argues, the disclosure of negotiated prices would throw a wrench in the health insurance market and de-incentivize companies to offer lower, more-competitive bids, which would in turn drive up prices. On top of that, it’s a violation of their Constitutional rights.
Also voicing their concerns with the rule were the Alliance of Community Health Plans, Association for Community Affiliated Plans, American Hospital Association, Business Group on Health and American Benefits Council.
“The council is deeply concerned that even with good faith efforts, plans may be unable to obtain some of the information needed to complete the required disclosures,” ABC wrote. “The council strongly urges that final regulations include a safe harbor to address this issue.”
Aside from concerns over being forced to divulge trade secrets, the groups were concerned with the administrative burden the new law will place on insurers and employers, the potential focus on fee-for-service versus value-based care, potential patient data privacy issues, and the confusion it would cause among consumers who don’t understand the context of the prices.
“The proposed rule would require health plans to provide information on all covered items and services. No existing transparency technology solution we are aware of supports this level of information — nor would they want to, since much of the required information could confuse and mislead consumers and the costs to implement would be enormous,” the Blue Cross and Blue Shield Association wrote.
BCBSA cited an analysis from Bates White that pegged the cost of compliance for an insurer at $13.6 million, much higher than the $510,000 estimated by the CMS.
“We have long supported efforts to make quality and pricing information more accessible, understandable and actionable for consumers. But they need real-time, patient-specific information tied to individual coverage benefits — not a massive published list of prices that may only frustrate consumers and likely increase costs over time,” wrote the Alliance of Community Health Plans.
Still, while they disagree with the CMS’s transparency rule, many in the health industry voiced their support for finding solutions to improve the patient experience.
“We fully support the goal of empowering Americans with easily accessible cost and quality information to make more informed decisions,” AHIP president and CEO Matt Eyles said. “AHIP strongly urges the Departments to adopt workable solutions that ensure health care information is personalized, easy to understand, accurate, and actionable, focusing on health care treatments and services for which consumers can actually shop.”
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