I’ve often tried to explain the current state of health care price variation to my mother and others not working in this crazy health care field.To bring it home to them, I’ve used the example of shopping for a toothbrush in a store. The shopper has many choices and can select the features in the price range desired and take it to the cashier and pay. Now, apply a health care pricing scenario to toothbrush purchasing: I select the toothbrush I want, but there are 20 different stickers on it, ranging from $.59 to $12.00. I take the toothbrush to the cashier and she peels off one of the stickers and I pay the price (say for sake of the story, I pay $5.00). It’s random to me, it’s unknown at point-of-purchase, and the value is not related in any way to price. We would not accept this in retail---so why do we accept this in health care?
As CMS embarks on listening sessions and issues a Request for Information (RFI) in their efforts to improve price transparency within CMS programs as part of a larger objective that aims to provide consumers the data needed to make more informed healthcare decisions. CMS, like states implementing APCDs, is seeking price transparency options to help consumers answer questions about unexpected costs for expensive healthcare services.
NAHDO will be commenting on the RFI and encourage state data agencies to do so as well to push for a collaborative process to align federal and state transparency goals and invite your suggestions/comments (firstname.lastname@example.org)
States have (and will continue) to be at the price transparency forefront and I am pleased that CMS, HHS, and Congress are on the price transparency wagon.However, as states have learned, there are many barriers to full health care price transparency. It is not an easy endeavor, but one that has to happen. We invite HHS, CMS, and the employer community to leverage the decades of work by states who have laid a foundation of standardizing and publicly revealing price information and together we can resolve common barriers related to provider identity, patient attribution, and expanding access to and improving the quality of the underlying data sources.
The current situation of payment and surprises in billing is not sustainable. A fragmented approach to solving the political and technical challenges (standards, ERISA, federal data gaps, etc.) also will not cut it. Let’s get CMS and HHS to collaborate with states.