The Real Truth About Price Transparency in Healthcare
INTERVIEW ON THE PRICE OF BUSINESS SHOW, MEDIA PARTNER OF THIS SITE.
Recently Kevin Price, Host of the nationally syndicated Price of Business Show, interviewed Dr. David Wilcox.
Health Transparency: The Real Truth with Dr. David Wilcox
On Jan 1st, 2022, we saw legislation passed to require hospitals to provide transparency to the cost of procedures they perform. The hospitals were supposed to list these costs in a consumer friendly format on their websites. To date, only 16% of hospital systems are compliant with this mandate. Minimal fines have been administered to those who are non-compliant. The feeling in the healthcare community is that hospital systems would rather roll the dice with the regulatory bodies who are charged with enforcing this mandate, than reveal consumers costs for procedures. Hospital systems are only becoming compliant after they have been fined.
While price transparency in healthcare being mandated by legislation is a positive sign, the enforcement of these mandates are key to the success of reversing a decades old trend of keeping the cost of healthcare away from the healthcare consumer. Hospitals would prefer the average healthcare consumer not to have this information. Armed with this information the healthcare consumer, especially those with high deductibles, could shop for better pricing such as having the surgery at an ambulatory surgical center which is often the less expensive option.
Recently the state of Colorado legislated that unless a hospital system complies with price transparency, they are not allowed to collect bad debt. They cannot send past due bills to bill collectors and furthermore, if they do collect past due debt, they have to refund it. Colorado will be the state to watch moving forward.
On July 1st, 2022, while everyone was firing up their grill for the fourth of July weekend, another piece of healthcare legislation went into effect. This legislation requires insurance companies to list the costs of a procedure and what they will cover in a consumer friendly format on their websites.
The insurance companies are watching how hospital systems consume the hospital price transparency rule carefully. Many of the insurance companies are complaining that they would need to hire additional staff to make this knowledge public. Yet these same insurance companies are able to send you an itemized bill after you access the healthcare system so getting that information on the front end which they do for prior authorizations shouldn’t be an issue.
The Centers for Medicare & Medicaid, perhaps learning from the lack of compliance with the hospital transparency rule, have upped the ante. Fines for the insurance companies are up to $100 a day per member for non-compliance. This could prove to be very costly for an insurance company to be non-compliant with the price transparency mandate.
Although healthcare transparency legislation is a move in the right direction the enforcement of these mandates is key to providing price transparency. Hospitals and insurance companies have painstakingly worked hard to keep the healthcare consumer in the dark about what their health care will cost. This causes many healthcare consumers to delay or avoid care altogether for fear they won’t be able to pay their healthcare bills. When consumers of healthcare delay accessing the healthcare system this almost always results in them becoming sicker which increases their costs.
Action Item: Armed with the information above, if you need a healthcare procedure done don’t put it off. Call your insurance company/hospital and let them know you understand they have to be transparent about the costs of your procedure/healthcare. If they aren’t, report them to the Centers for Medicare and Medicaid using their website.
Next month: We will cover how the Inflation Reduction bill touches healthcare and what you can expect as a healthcare consumer.
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According to a statement, “Healthcare is complex and that is not an accident. It is complex by the healthcare entities vying for your healthcare dollars. Covid has exacerbated the American Healthcare System, which was fragile, to begin with. Many clinicians are leaving healthcare due to burnout. How does the average layperson navigate the complexities of the American Healthcare System where a prescription could cost you $5 at one pharmacy and $500 at another? What does the average layperson do when their insurance company rejects their claim? Proactive education of the American Healthcare System prior to accessing it is the key to safely navigating the healthcare system. Until now, little information has been available to provide the layperson with the knowledge they need to be a better partner in their health care. Dr. David Wilcox’s book How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival” is a game-changer and will provide you with the skill set you need to navigate the American Healthcare System.
Website: https://drdavidwilcox.com/
Dr. Wilcox is a Doctorate prepared nurse who also holds a Masters in Health Administration and is Board Certified in Nursing Informatics. Dr. Wilcox has 28 years of healthcare experience in which he worked as a bedside nurse, hospital administrator, and in healthcare information technology which has helped him to develop his unique perspective on the American Healthcare System.
Dr. Wilcox is the author of the book “How to Avoid Being a Victim of the American Healthcare System: A Patient’s Handbook for Survival (2021)” available at https://www.amazon.com/dp/0578878364
Dr. Wilcox currently resides in North Carolina with his wife and their three dogs.
Dr Wilcox’s website: Dr. David Wilcox – Healthcare, American Healthcare System (drdavidwilcox.com)
LISTEN TO THE INTERVIEW IN ITS ENTIRETY HERE
