The President released his approach to solving the surprise billing problem today. Principally
The Administration wants to ensure patients are not price gouged in emergency situations by out-of-network providers they could not choose. In emergency situations, balance billing for amounts above the in-network allowed amount should be prohibited.
The Administration wants to bring transparency to the confusing and opaque pricing system patients face when scheduling care. Before scheduling their care, patients should be given information about whether the care providers are out of their network and what related costs that may bring.
The FEHBlog’s preferred approach to emergency care is having each hospital require their affiliated providers to participate in the same networks in which the hospital participates.
Beckers Hospital Review reports that UniedHeathcare has rolled out a new bundled maternity care package.
The bundled payment program, launched with two healthcare providers in New Jersey and Texas, will reimburse care providers or a hospital for an episode of care — including prenatal, delivery and postpartum services — under a single payment. The bundled payments will link provider reimbursement to care outcomes. The program, developed in partnership with healthcare provider organization U.S. Women’s Health Alliance, is slated to encompass up to 20 provider groups by the end of the year.
Smart move.
The Senate Health Education Labor and Pensions Committee held a hearing on the 21st Century Cures Act on Tuesday. Healthcare Dive provides a report on the hearing which considered the proposed HHS interoperability rule. The FEHBlog thinks that there good ideas in these rules which will help implement the President’s second no surprises principle stated above. However, HHS proposes to implement these technology driven changes way too fast, to wit, January 1, 2020. The Committee Chairman agrees:
“My major concern is to remind the administration of the advice that my piano teacher used to give me before a recital,” committee chairman Lamar Alexander, R-Tenn., said. “She’d say, ‘Lamar, play it a little slower than you can play it. You’re less likely to make a mistake.'”
Well put, Mr. Chairman. Also don’t bite off more than you can chew.
Modern Healthcare reports on a recent RAND study finding that employer sponsored health plans pay hospitals 241% more than Medicare for the same services.
“If you ask hospitals, they will pretty commonly say that ‘our prices are high because we lose money on Medicaid patients and barely break even on Medicare.’ But if you kind of look at the data, that story doesn’t hold up that well empirically,” said Christopher Whaley, one of the study’s authors. “Sometimes hospitals that can charge higher prices because of market clout, reputation or must-have status do so.”
[Affordable Care Act driven] Consolidation among hospitals across the nation has helped boost their ability to negotiate higher prices from health plans, studies have shown. If employers and health plans participating in the study paid hospitals Medicare rates, they would have paid $7 billion, or about 50%, less over the study period, researchers concluded.
AIS Health provides a useful article on the annual drug trend reports (including links) for three large prescription benefit managers — CVS Health / Caremark, Express Scripts and Prime Therapeutics. Check it out.