Earlier this year, we discussed“The Debate Over Transparency.” That topic involves providing more information to the public about all aspects of healthcare operations. One key part of this relates to price transparency and hospitals. Up until now, many factors related to the prices charged have been obscured.
New Court Ruling on Price Transparency and Hospitals
While yet a done deal, a major court decision will promote more price transparency in hospitals. Then, why is this not a done deal? Experts expect appeals of the verdict. For insights, we turn to two Fierce Healthcare articles by Robert King.
[Last week], “a federal judge ruled against a lawsuit brought by hospital groups that challenges the Trump administration’s rule to require hospitals post charges they negotiate with payers. The ruling issued by the U.S. District Court for the District of Columbia dealt a major blow to hospitals — as well as insurers — who claimed the Centers for Medicare & Medicaid Services’ rule that goes into effect in January is onerous.”
“Hospital groups sued CMS late last year charging the agency did not have the statutory authority to mandate the rule. It requires hospitals post payer-negotiated charges in order to give consumers more transparency. The judge also shot down hospitals’ arguments about the burden of the rule. The lawsuit said that the rule could require hospitals to publish a long list of charges because a hospital often negotiates a different charge with a different payer for the same service or procedure.”
“A court ruling upholding a controversial price transparency rule puts hospitals in a tight spot. How to comply with the regulation in the middle of a pandemic. Even though the groups issued plans to appeal, hospitals must weigh whether to start preparing for the rule. It goes into effect on Jan. 1, 2021.”
“’They need to be thinking about the practical implications of their compliance. They must make public information about pricing that has not up until now been public.’ According to Michael Abrams managing partner of the consulting firm Numerof Associates.”
“But hospitals have been hit hard by the COVID-19 pandemic. With some systems furloughing or laying off people. As well as clinical staff stretched to the limit to deal with cases.”
Employer healthcare spending could fall in calendar year 2020 compared with 2019, and then rebound in 2021. How much it falls in 2020 and rebounds in 2021 is subject to many variables.
For 2021, PwC’s Health Research Institute (HRI) has formulated three scenarios to help guide employers and health plans as they determine the medical cost trend. A high-spending scenario, in which spending grows significantly higher in 2021 after being down in 2020, forecasts a 10% medical cost trend. A medium-spending scenario, in which spending grows at roughly the same rate in 2021 as it did from 2014 to 2019, projects a 6% medical cost trend. And a low-spending scenario, in which spending remains dampened in 2021, translates to a 4% medical cost trend.
While spending may be up in 2021 over 2020, HRI identified two bright spots. (1) Health has gained ground slowly for years. COVID-19 forced its rapid adoption by both consumers and clinicians. In 2021, HRI expects telehealth to be a viable and desirable alternative to in-person care. Saving employers and health plans on the episodic cost of care delivered virtually. (2) Networks narrow out of necessity. Over a quarter of employers have considered this for the past few years. Some of those employers may move to a narrow network plan in 2021 as COVID-19 and the related economic downturn force employers to shed costs. As well as make healthcare providers more willing in the short term to give price concessions or take on more risks in exchange for predictable cash flows. If it helps them get patients to return.
“It has been around two months of quarantine for many of us. The urge to get out and enjoy the summer is real. But what’s safe? We asked a panel of infectious disease and public health experts to rate the risk of summer activities, from backyard gatherings to a day at the pool to sharing a vacation house with another household.”
“One big warning: Your personal risk depends on your age and health, the prevalence of the virus in your area, and the precautions you take during any of these activities. Also, many areas continue to restrict the activities described here, so check your local laws.”
“And there’s no such thing as a zero-risk outing right now. As states begin allowing businesses and public areas to reopen, decisions about what’s safe will be up to individuals. It can help to think through the risks the way the experts do.”
“‘We can think of transmission risk with a simple phrase: time, space, people, place,” explains Dr. William Miller, an epidemiologist at Ohio State University. Here’s his rule of thumb: The more time you spend and the closer in space you are to any infected people, the higher your risk. Interacting with more people raises your risk, and indoor places are riskier than outdoors.’
To see what is low risk and what is high risk, click on an activity: