The New Year Brings More Transparency In Hospital Prices With New Federal Health Care Rule

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BY SCOTT SIMON

A new federal health care rule will require hospitals to publicly post prices for every service they offer and break down those prices by component and procedure. The idea behind the Transparency in Coverage rule is to let patients choose where to go, taking price into consideration.

The Trump administration’s rule, which goes into effect this month, was made possible in part through the efforts of Cynthia Fisher, the founder and chairman of PatientRightsAdvocate.org. Patients from across the United States have told “stories of being blindsided by outrageous medical bills,” Fisher told NPR’s Weekend Edition. “This is the win to put affordable into the Affordable Care Act. It’s golden.”

Below are highlights of the interview edited for length and clarity.

Interview Highlights

Why do you think it’ll drive down costs?

We were also able to bring to the administration innovative surgical centers that already started this price-transparent world. And what these employers were able to do by contracting these price transparent centers is for around $15,000, get a knee replacement. In many of the opaque hospital systems where prices are hidden, we’ve seen knee replacements as high as $60,000 to $75,000. When we can save nearly $50,000 on a knee replacement, that’s a huge savings to not only the individuals and their families, but also their employers.

A new federal health care rule requires hospitals to publicly post prices for every service they offer and break down those prices by component and procedure. CREDIT: Catie Dull/NPR

It’s also been said that instead of inspiring high-priced hospitals and surgical centers to lower their prices, this might just inspire the lower-cost hospitals and surgical centers to say, “Hey, we can get people to pay more for a heart stent or spinal fusion so we’re going to raise our prices.”

You know, in every other marketplace in our economy, the consumers benefited from competition. So when hospitals have to compete for our hard-earned dollars, what we can see as consumers is we’ll shop with our feet to get the best quality of care at the lowest possible price. Think about it. Why didn’t we know prices in health care? It’s almost absurd. And now that’s over.

Any concern that people are going to make their judgments according to price? When all is said and done, do you really want to get the cheapest hip replacement possible or the best?

Well, there’s wide variation in prices within the same facility. So, for instance, an MRI in Boston at a discounted cash price can be $250. In the same facility, you can pay as high as $2,000 from an insured negotiated rate. The only way that a consumer can benefit to get that lower rate is to know those price variations and not stand for being price-gouged.

I think some people listening to our conversation might think this is the regretful thing about the American health care system. People have to shop to receive health care. Why shouldn’t it just be their right to have the lowest possible price?

Well, I agree with you that it should be the American consumer’s right to have the lowest possible price. I can share with you, Scott, that this week, the American consumers won in the courts and no more will we have those surprise bills. Every bill’s been a surprise.