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.
Three scenarios for curing COVID-19. Which one will be right?
We still have a lot of uncertainty about where things are heading with COVID-19. Thus, it is helpful to consider some of the possible scenarios that exist with regard to treating and preventing the disease.
SynBioBetais proud to partner withLeaps by Bayerto make a visual timeline for COVID-19 treatment and prevention. The scientific community is working around the clock, not only to protect us from COVID-19, but to prevent future strains from causing disruption and chaos.
We invite you to share this infographic with friends, family, and peers in your digital community, to bring much needed awareness to the synthetic biology solutions being developed, as well as the underlying science employed in developing both preventative measures and future treatments.