Price Transparency en Hospital Price Transparency Final Rule <span class="title">Hospital Price Transparency Final Rule</span> <span class="uid"><span>dsamuels_drupal</span></span> <span class="created">Apr 12, 2021 - 04:34 PM</span> <div class="body"><div class="container"> <div class="row"> <div class="col-md-8"> <h3><strong>The Centers for Medicare &amp; Medicaid Services’ Hospital Price Transparency final rule goes into effect on Jan. 1, 2021.</strong></h3> <h2>Issue</h2> <p>The Centers for Medicare &amp; Medicaid Services’ (CMS) hospital price transparency final rule, issued Nov. 14, 2019, will require hospitals to provide an out-of-pocket price estimator tool or information on 300 “shoppable” services for patients as well as disclose their privately negotiated rates with health insurers, discounted cash prices and gross charges beginning Jan. 1, 2021. The agency will monitor and enforce compliance, including civil monetary penalties of up to $300 a day</p> <h2>AHA Take</h2> <p>Hospitals and health systems are committed to providing patients with meaningful information that patients can use to make the best decisions for themselves and their families, such as an out-of-pocket cost-estimator tool for shoppable services. However, the AHA continues to oppose the requirement to publicly list privately negotiated prices. That part of the rule will do nothing to help patients become more knowledgeable consumers of health care and instead will confuse and frustrate them. And, according to one large national health insurer, it will accelerate anticompetitive behavior by insurers with market power including stymieing badly needed innovations in care delivery.</p> <p>The U.S. Court of Appeals for the District of Columbia Circuit Oct.15 heard oral arguments in an appeal from the AHA and hospital groups challenging CMS’ final rule. We urged the court to overturn the rule and do so quickly due to the looming Jan.1 compliance deadline and the unreasonable burden it places on hospitals. Concurrent with our legal strategy, we have been working to prepare the field for the rule’s implementation, should it take effect on Jan. 1.</p> <h2>AHA Resources</h2> <p>AHA offers resources to help you meet patient demand for easier access to out-of-pocket cost estimates. These resources also can help you implement the hospital price transparency rule shoppable service requirement. We also partnered with AVIA, a digital health consultant firm, and Deloitte to create educational opportunities related to implementation.</p> <p>See below for a collection of all AHA and CMS resources related to this final rule. This webpage will be updated regularly as new resources are available.</p> <hr /><a id="ptvideo"></a><iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="" frameborder="0" height="315" src="" width="560"></iframe> <p>AHA members, <a href="">download an unbranded version of this video</a> to share with your communities on your website. Use the "Download" or "Save video as" link within the video player option menu to download the .mp4 video file. You may need to right click on the video for this menu to appear.</p> <hr /> <div class="col-md-12 cc_tabs"> <style type="text/css">/* reset */ .cc_tabs ul.a-container { margin: 0; padding: 0; list-style: none; } .cc_tabs input[type=checkbox] { display: none; } /* style */ .cc_tabs .a-container { width: 100%; margin: 20px auto; } .cc_tabs .a-container label { display: block; position: relative; cursor: pointer; font-size: 18px; font-weight: bold; padding: 10px 20px; color: #63666a; background-color: #eee; border-bottom: 1px solid #ddd; -webkit-transition: all .2s ease; -moz-transition: all .2s ease; -ms-transition: all .2s ease; -o-transition: all .2s ease; transition: all .2s ease; margin-bottom:15px } .cc_tabs .a-container label:after { content: ""; width: 0; height: 0; border-top: 8px solid #aaa; border-right: 6px solid transparent; border-bottom: 8px solid transparent; border-left: 6px solid transparent; position: absolute; right: 10px; top: 16px; } .cc_tabs .a-container input:checked + label, .cc_tabs .a-container label:hover { background-color: #003087; color: #fff; } .cc_tabs .a-container input:checked + label:after { border-top: 8px solid transparent; border-right: 6px solid transparent; border-bottom: 8px solid #fff; border-left: 6px solid transparent; top: 6px; } .cc_tabs .a-content { padding: 0 20px 20px; display: none; height:auto; max-height: 40vh; overflow: auto } .cc_tabs .a-container input:checked ~ .a-content { display: block; } </style> <style type="text/css">/* Style the tab */ .cc_tabs .tab { background-color: #fff; width: auto; height: auto; overflow: auto; } /* Style the buttons inside the tab */ .cc_tabs .tab button { display: block; background-color: lightgry; color: #003087; padding: 10px 16px 10px 20px; width: calc(50% - 30px); border: solid 1px lightgray; outline: none; text-align: center; cursor: pointer; transition: 0.3s; font-size: 20px; float: left; overflow: auto; margin: 0px 15px; -webkit-border-top-left-radius: 15px; -webkit-border-top-right-radius: 15px; -moz-border-radius-topleft: 15px; -moz-border-radius-topright: 15px; border-top-left-radius: 15px; border-top-right-radius: 15px; font-weight: 700; } @media (max-width:452px){ .cc_tabs .tab button{ padding: 10px 5px 10px 5px; width: calc(50% - 4px); font-size: 17px; margin: 0px 2px; } } /* Change background color of buttons on hover */ .cc_tabs .tab button:hover { background-color: #003087; color:#fff } /* Create an active/current "tab button" class */ .cc_tabs .tab { background-color: #003087; color: #ffffff } /* Style the tab content */ .cc_tabs .tab .tabcontent { float: left; padding: 15px 12px; border: 1px solid #ccc; width: 100%; height: auto; } .cc_tabs .tablinks:after { content: '\2610'; color: #777; font-weight: bold; float: right; margin-left: 5px; } .cc_tabs { content: "\2611"; } </style> <!-- <div class="tab"><button class="tablinks" id="defaultOpen" onclick="openCity(event, 'Certified')">Get Certified</button><button class="tablinks" onclick="openCity(event, 'Recertify')">Recertify</button></div> --> <div class="tabcontent" id="General"><a id="patienttools"> </a> <a id="patienttools"></a> <ul class="a-container"><!-- item01 --> <li class="a-items"><input id="z1" name="ac" type="checkbox" /> <label for="z1">Rule Summary</label> <div class="a-content"> <ul> <li><a href="">Special Bulletin: CY 2022 Hospital OPPS/ASC Final Rule, Including Modifications to Price Transparency </a></li> <li><a href="">CY 2022 Hospital OPPS/ASC Proposed Rule, Including Modifications to Price Transparency</a></li> <li><a href="">AHA Special Bulletin on Proposed Updates to Rule</a></li> <li><a href="">AHA Regulatory Advisory</a></li> <li><a href="">AHA Special Bulletin</a></li> </ul> </div> </li> <!-- item02 --> <li class="a-items"><input id="z2" name="ac" type="checkbox" /> <label for="z2">AHA Advocacy </label> <div class="a-content"> <ul> <li><a href="">AHA letter to CMS on Implementing the No Surprises Act’s Price Transparency Provisions </a></li> <li><a href="">AHA Letter Urging Sec. Azar to Exercise Enforcement Discretion with Respect to the Hospital Price Transparency Rule</a></li> <li><a href="">AHA Special Bulletin: AHA Urges Court to Delay Implementation of Price Transparency Rule; Asks Biden Transition Team for Enforcement Discretion</a></li> <li><a href="">AHA Letter to Biden-Harris Transition Team on Price Transparency Rule</a></li> <li><a href="/lettercomment/2020-12-11-aha-outlines-initial-policy-priorities-biden-administration">AHA Letter to President-elect Biden (includes request for delay in enforcement)</a></li> <li><a href="/lettercomment/2020-12-02-aha-hhs-re-additional-covid-19-flexibilities-providers">Letter to Sec. Azar re: Additional COVID-19 Flexibilities (includes request for delay in enforcement)</a></li> <li><a href="">AHA Comments on the Proposed Policy</a></li> <li><a href="">AHA Letter requesting a delay</a></li> </ul> </div> </li> <!-- item03 --> <li class="a-items"><input id="z3" name="ac" type="checkbox" /> <label for="z3">AHA Lawsuit</label> <div class="a-content"><a> </a> <p class="MsoNormal"><span style="font-size:16.0pt;line-height:107%;font-family:&quot;Arial&quot;,sans-serif"><o:p></o:p></span></p> <ul> <li><a href="/system/files/media/file/2020/12/2020-12-23-Appellee-US-Opposition-to-Emergency-Motion-to-Stay.pdf">Appellee U.S. Opposition to Emergency Motion to Stay</a> (December 23, 2020)</li> <li><a href="">Hospitals’ Emergency Motion for Stay </a>(December 21, 2020) <ul> <li><a href="">Exhibit 1</a></li> <li><a href="">Exhibit 2</a></li> <li><a href="">Exhibit 3</a></li> </ul> </li> </ul> <ul> <li><a href="">Hospital Group Responds to Government’s Notice About Recent Guidance </a>(October 2, 2020)</li> <li><a href="">Government Notifies Court of Recently Released Guidance on Negotiated Charges Rule Implementation </a>(October 1, 2020)</li> <li><a href="">Government Responds to Hospital Group Letter on the Executive Order </a>(October 1, 2020)</li> <li><a href="/legal-documents/2020-09-28-hospital-group-notifies-court-recent-price-transparency-executive-order">Hospital Group Notifies Court of Recent Price Transparency Executive Order </a>(September 25, 2020)</li> <li><a href="/legal-documents/2020-09-28-govt-responds-hospital-groups-previous-notice-court-re-additional">Govt. Responds to Hospital Groups’ Previous Notice to the Court about Additional Disclosure Required In 2021 IPPS Final Rule </a>(September 25, 2020)</li> <li><a href="">Hospital Group Notifies Court of Relevant Supplemental Authority </a>(September 21, 2020)</li> <li><a href="">Hospital Groups Reply to Government </a>(August 28 2020)</li> <li><a href="">Government’s Reply Brief In Negotiated Charges Appeal</a> (August 14, 2020)</li> <li><a href="">Hospital Associations Amicus Brief in Negotiated Charges Appeal</a> (July 24, 2020)</li> <li><a href="">US Chamber Amicus Brief in Negotiated Charges Appeal</a> (July 24, 2020)</li> <li><a href="">HFMA Amicus Brief in Negotiated Charges Appeal</a> (July 24, 2020)</li> <li><a href="">Opening Appeals Brief</a> (July 17, 2020)</li> <li><a href="">D.C. Circuit’s Order Adopting AHA Recommended Expedited Briefing Schedule for Appeal</a> (July 7, 2020)</li> <li><a href="">Motion to Expedite Appeal</a>&nbsp;(July 3, 2020)</li> <li><a href="/legal-documents/2020-06-24-notice-appeal-court-decision-public-disclosure-negotiated-rates-june-23">Notice of Appeal</a> (June 23, 2020)</li> <li><a href="">Court Decision in Disclosure of Negotiated Charges Lawsuit</a> (June 23, 2020)</li> <li><a href="">Government’s Reply Brief in Disclosure of Negotiated Charges Lawsuit</a> (March 24, 2020)</li> <li><a href="">Court Sets April 22 Hearing Date in AHA’s Challenge to the Rule Requiring Hospitals to Disclose Negotiated Charges</a> (March 5., 2020)</li> <li><a href="">US Chamber of Commerce Files Amicus Brief Supporting Legal Challenge to Rule Requiring Disclosure of Negotiated Charges</a> (Feb. 28. 2020)</li> <li><a href="">AHA Reply Brief in Case to Prevent Disclosure of Negotiated Contracts</a> (Feb. 28, 2020)</li> <li><a href="">Amicus Brief of the State Hospital Associations in Support of AHA Lawsuit Challenging Disclosure of Negotiated Charges Rule</a> (Feb. 28, 2020)</li> <li><a href="/system/files/media/file/2020/02/government-moves-for-summary-judgement-in-disclosure-of-negotiated-charges-lawsuit-2-4-2020.pdf">Government Moves for Summary Judgement in Disclosure of Negotiated Charges Lawsuit</a> (Feb. 4, 2020)</li> <li><a href="">Scheduling Order Signed by Judge Nichols</a> (Dec. 18, 2019)</li> <li><a href="/system/files/media/file/2019/12/joint-motion-for-scheduling-order-disclosure-of-negotiated-charges-12-13-19-.pdf">Joint Motion for Scheduling Order</a> (December 13, 2019)</li> <li><a href="/system/files/media/file/2019/12/aha-hospital-group-brief-in-support-of-their-motion-for-summary-judgment-disclosure-of-negotiated-charges-12-9-19.pdf">AHA, Hospital Group Brief in Support of Their Motion for Summary Judgment</a> (Dec. 9, 2019)</li> <li><a href="/system/files/media/file/2019/12/hospital-groups-lawsuit-over-illegal-rule-mandating-public-disclosure-individually-negotiated-rates-12-4-19.pdf%20.pdf">Hospital Groups File Lawsuit Over Illegal Rule Mandating Public Disclosure of Individually Negotiated Rates</a>, (December 4, 2019)</li> </ul> </div> </li> <!-- item04 --> <li class="a-items"><input id="z4" name="ac" type="checkbox" /> <label for="z4">AHA Member Resources for Implementation</label> <div class="a-content"> <h4>Internal Communications Tools for Hospitals</h4> <ul> <li><a href="/other-resources/2020-12-17-price-transparency-action-items">Price Transparency Action Items</a></li> <li><a href="/infographics/2020-12-17-communicating-about-price-transparency">Communicating About Price Transparency</a></li> <li><a href="/infographics/2020-12-22-hospital-price-transparency-infographic">Price Transparency Infographic</a></li> <li><a href="/2020-12-18-price-transparency-sample-patient-and-media-messages">Price Transparency Sample Patient and Media Messages</a></li> <li><a href="/other-resources/2020-12-17-price-transparency-secret-shopper-exercise">Price Transparency Secret Shopper Exercise</a></li> <li><a href="/assessment/2020-12-17-price-transparency-self-assessment">Price Transparency Self-assessment</a></li> <li><a href="/2020-12-18-price-transparency-tough-questions-answers">Price Transparency Tough Questions and Answers</a></li> </ul> <h4>Other Resources</h4> <ul> <li><a href="/special-bulletin/2021-08-23-departments-hhs-labor-and-treasury-release-faqs-transparency-no">AHA Special Bulletin: Departments of HHS, Labor, and Treasury Release FAQs on Transparency, No Surprises Act Regulations</a></li> <li><a href="">AHA Special Bulletin: Updated AHA Guidance on Hospital Price Transparency Rule That Took Effect Jan. 1 </a></li> <li><a href="/advisory/2021-05-03-cms-begins-issuing-warning-notices-hospitals-noncompliance-hospital-price">AHA Member Advisory: CMS Begins Issuing Warning Notices to Hospitals for Noncompliance with Hospital Price Transparency Rule</a></li> <li><a href="">AHA Member Advisory: Media Guidance and Other New Resources Available to Prepare for Hospital Price Transparency Rule That Takes Effect Jan. 1, Dec. 22, 2020 </a></li> <li><a href="">Podcast: Price Transparency and Out-of-pocket Calculators</a></li> <li><a href="">Cleverley + Associates Webinar on Strategies and Solutions</a></li> <li><a href="">PARA Healthcare Analytics Webinar on Strategies and Solutions</a></li> <li><a href="">AHA Member Advisory</a></li> <li><a href="">Patient Out-of-pocket Cost Estimator Toolkit </a>(includes Members in Action case studies)</li> <li><a href=";activeTab=Feed">AVIA Connect Virtual Panel on Implementation</a> (access granted with log-in information)</li> <li><a href="">AVIA-Deloitte Webinar on Strategic Considerations for Implementation</a> (access granted with log-in information)</li> <li><a href="">Webinar: Price Transparency Updates on August 25, 2021</a></li> </ul> </div> </li> <!-- item05 --> <li class="a-items"><input id="z5" name="ac" type="checkbox" /> <label for="z5">CMS Resources </label> <div class="a-content"> <ul> <li><a href="">CMS Hospital Transparency Website</a></li> <li><a href="">FY 2020 Price Transparency Requirements for Hospitals To Make Standard Charges Public</a></li> <li><a href="">Frequently Asked Questions</a></li> <li><a href="">8 Steps to a Machine-readable File</a></li> <li><a href="">10 Steps to a Consumer-Friendly Display</a></li> <li><a href="">Quick Reference Checklist</a></li> </ul> </div> </li> <!-- item06 --> <li class="a-items"><input id="z6" name="ac" type="checkbox" /> <label for="z6">AHA Resources on Related Policies</label> <div class="a-content"> <ul> <li><a href="">Member Advisory: Update on Federal Price Transparency Policies </a></li> <li><a href="">AHA’s Surprise Billing Webpage </a></li> <li><a href="">Special Bulletin: Administration Finalizes Rule Requiring Health Plans to Disclose Negotiated Rates</a></li> <li><a href="">Special Bulletin: Proposed Insurer Price Transparency Policy</a></li> <li><a href="">AHA comments on Proposed Insurer Price Transparency Policy</a></li> <li><a href="">AHA Advisory – 2019 Update to Disclosure of Standard Charge Policy</a></li> </ul> </div> </li> </ul> </div> <!-- <div class="tabcontent" id="Recertify"> <ul class="a-container"> <!== item01 == <li class="a-items"> <input id="b1" name="ad" type="checkbox" /> <label for="b1">item 1</label> <div class="a-content"> <p>====</p> </div> </li> </ul> <div> --><script> function openCity(evt, cityName) { var i, tabcontent, tablinks; tabcontent = document.getElementsByClassName("tabcontent"); for (i = 0; i < tabcontent.length; i++) { tabcontent[i].style.display = "none"; } tablinks = document.getElementsByClassName("tablinks"); for (i = 0; i < tablinks.length; i++) { tablinks[i].className = tablinks[i].className.replace(" active", ""); } document.getElementById(cityName).style.display = "block"; evt.currentTarget.className += " active"; } // Get the element with id="defaultOpen" and click on it document.getElementById("defaultOpen").click(); </script></div> </div> <div class="col-md-4"> <p class="text-align-center"><strong><a class="btn btn-primary btn-wide" href="">December 22 AHA Advisory<br /> with New Resources to Prepare for Hospital Price Transparency Rule That Takes Effect Jan. 1</a></strong></p> <div class="panel module-typeC"> <div class="panel-heading"> <center> <h3 class="panel-title" style="color: #9d2235;">Key Takeaways</h3> </center> </div> <div class="panel-body"> <p>As of Jan. 1, 2021, hospitals are required to:</p> <ul> <li>Post a list of five types of standard charges – now defined as gross charges, payer-specific negotiated rates, de-identified minimum and maximum negotiated rates, and discounted cash price – for all items and services in a machine-readable format on their websites.</li> <li>Provide payer-specific rates for at least 300 “shoppable” bundles of services in a consumer-friendly format. Hospitals with a qualified price estimator tool meet this requirement.</li> </ul> <p>Noncompliance is subject to civil monetary penalties.</p> <p>The AHA and three other national organizations sued the federal government challenging the final rule; the case is pending an appeal.</p> </div> </div> </div> </div> </div> </div> <div class="field_media_featured_image"><article> <div class="field_media_image"> <img src="/sites/default/files/2020-10/price-transparency-960-desk-setting.jpg" width="960" height="376" alt="Price Transparency Desk Setting Image 960px " loading="lazy" /> </div> </article> </div> <div class="field_topics"> <div><a href="/topics/price-transparency" class="topic" hreflang="en">Price Transparency</a></div> </div> <div class="field_type"> <div>Type</div> <div><a href="/taxonomy/term/119" hreflang="en">Legal Documents</a></div> </div> <div class="field_access_level"> <div>Access Level</div> <div><a href="/taxonomy/term/279" hreflang="en">Member</a></div> </div> <div class="field_lead"><!-- Page changes --> <style type="text/css">.jumbotron.clearfix, .meta-share.clearfix{ display: none } #page-content.spacer{ padding-top: 0px !important; } </style> <div class="container"> <style type="text/css">/* Banner_Title_Overlay_Bar */ .Banner_Title_Overlay_Bar { position: relative; display: block; overflow: hidden; max-width: 1170px; margin: 0px auto 25px auto; } .Banner_Title_Overlay_Bar h1 { position: absolute; bottom: 40px; color: #003087; background-color: rgba(255, 255, 255, .8); width: 100%; padding: 20px 40px; font-size: 3em; box-shadow: 0 3px 8px -5px rgba(0, 0, 0, .6); } .Banner_Title_Overlay_Bar img { width:100%; } @media (max-width:991px) { .Banner_Title_Overlay_Bar h1 { bottom: 0px; margin: 0px; font-size: 2.5em; } } @media (max-width:767px) { .Banner_Title_Overlay_Bar h1 { font-size: 2em; text-align: center; text-indent: 0px; padding: 10px 20px; } } @media (max-width:530px) { .Banner_Title_Overlay_Bar h1 { position: relative; background-color: #63666A22; } } /* Banner_Title_Overlay_Bar // */ </style> <!-- Banner_Title_Overlay_Bar --> <header class="Banner_Title_Overlay_Bar"><img src="/sites/default/files/2020-10/price-transparency-960-desk-setting.jpg" /> <div> <h1>Hospital Price Transparency Final Rule</h1> </div> </header> </div> <!--//--></div> <div class="field_promoted_search_terms"> <div>Promoted Search Terms</div> <div>price transparency</div> </div> <div class="field_search_promotion"> <div>Search Promotion</div> <div>Promoted</div> </div> <div class="field_archived"> <div>Archived</div> <div>Off</div> </div> Mon, 12 Apr 2021 21:34:23 +0000 dsamuels_drupal 673674 at RAND’s solutions for lowering health care costs are ineffective and potentially harmful <span class="title">RAND’s solutions for lowering health care costs are ineffective and potentially harmful</span> <span class="uid"><span>tjordan_drupal</span></span> <span class="created">Mar 5, 2021</span> <div class="field_media_featured_image"><article> <div class="field_media_image"> <img src="/sites/default/files/styles/900x400/public/2019-10/rick-pollack-banner-900x400.jpg?itok=OKwgFu_e" width="900" height="400" alt="Rick Pollack in front of American Hospital Association seal and American flag" loading="lazy" /> </div> </article> </div> <div class="body"><p><span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial&quot;,sans-serif">A recent report from RAND misses the mark on solutions to the cost of health care and draws its conclusions from the same recycled and incomplete studies.</span></span></span></span></p> <p><span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial&quot;,sans-serif">Physicians, nurses and all health professionals do extraordinary and often heroic work that no other part of the health care system can. The COVID-19 pandemic is just one example of the essential and life-saving care provided at all times, 24 hours a day, 7 days a week. That means having at the ready highly trained personnel, novel drug therapies and advanced technologies to respond to anything from burns and cardiac failure to delivering a baby. </span></span></span></span></p> <p><span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial&quot;,sans-serif">During the past year, hospitals and health systems cared for their communities in all of these ways despite unprecedented financial challenges. A new <a href="" style="color:#0563c1; text-decoration:underline">analysis</a> prepared for the AHA by Kaufman Hall and Associates forecasts that total hospital revenue in 2021 could be down between $53 billion and $122 billion from pre-pandemic levels. Hospitals and health systems have also experienced increases in many expenses due to COVID-19 in 2020 compared with 2019. This comes on the heels of years of price moderation, with the <a href="" style="color:#0563c1; text-decoration:underline">Bureau of Labor Statistics</a> finding hospital prices grew an average of just 1.9% each year over the last decade. </span></span></span></span></p> <p><span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial&quot;,sans-serif">Against this backdrop, RAND puts forward ineffective and potentially harmful policy options that broadly fit into three categories: rate regulation, price transparency and increased competition. </span></span></span></span></p> <p><span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,sans-serif"><b><span style="font-family:&quot;Arial&quot;,sans-serif">Rate regulation: </span></b><span style="font-family:&quot;Arial&quot;,sans-serif">Rate regulation is not an effective strategy for reducing consumer health spending. One key reason rate regulation won’t work: Medicare rates do not cover the cost of providing care to Medicare patients. Medicare paid only 87 cents for every dollar hospitals spent caring for Medicare patients in 2019. This resulted in an <a href="" style="color:#0563c1; text-decoration:underline">underpayment</a> of nearly $57 billion. Linking commercial prices to Medicare levels would pull desperately needed resources away from hospitals, especially when more than a quarter already experienced negative margins before the pandemic. </span></span></span></span></p> <p><span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,sans-serif"><b><span style="font-family:&quot;Arial&quot;,sans-serif">Price transparency: </span></b><span style="font-family:&quot;Arial&quot;,sans-serif">Hospitals and health systems vigorously support and are already working to help patients estimate and better understand what they will pay for care. In addition, new price transparency rules require hospitals to publish negotiated rates. RAND’s solutions would either add another layer of bureaucracy or require hospitals to shift gears <i>yet again</i> and publish these data in a different way.</span></span></span></span></p> <p><span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial&quot;,sans-serif">Also, as the authors themselves note, price transparency is only effective if patients use the tools. Studies show consumers in high-deductible health plans, with the highest incentive to price compare, do not regularly shop around even when data and price comparison tools are available. That’s why hospitals are focused on bridging these gaps by developing tools that engage patients and promote financial literacy.</span></span></span></span></p> <p><span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,sans-serif"><b><span style="font-family:&quot;Arial&quot;,sans-serif">Increasing competition: </span></b><span style="font-family:&quot;Arial&quot;,sans-serif">The last prescription — to “increase competition” — is the weakest. RAND <a href="" style="color:#0563c1; text-decoration:underline">ignored findings</a> that are inconsistent with their point of view, such as hospital consolidation being linked to a 2.3% reduction in annual operating expenses and a 3.5% decline in revenues per admission. During the pandemic, many systems were able to redeploy staff when surges occurred, or to find new supply chains to deliver personal protective equipment and other supplies and to do outreach to underserved communities in a targeted manner.</span></span></span></span></p> <p><span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial&quot;,sans-serif">Further, no credible argument about market power can dismiss consolidation among health insurers, as RAND does. Nearly 3 in 4 health insurance markets (74%) were <a href="" style="color:#0563c1; text-decoration:underline">highly concentrated</a> in 2019, according to the American Medical Association. At the same time, health insurers are injecting themselves into other parts of the supply stream by buying physician practices and pharmacy benefit managers. Researchers have drawn a <a href=",insurers'%20lowest%2Dcost%20plans" style="color:#0563c1; text-decoration:underline">direct link</a> between insurer monopolies and higher premiums — a 2018 study of marketplace plans found premiums were on average 50% higher in areas with just one insurer compared to those with more than two insurers.</span></span></span></span></p> <p><span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Arial&quot;,sans-serif">Even RAND acknowledges their prescriptions could do more harm than good. Co-author and RAND policy researcher Christopher Whaley said in a statement: “Regulating commercial hospital prices is a direct way to create significant reductions in spending, but doing so could potentially lead to hospital closures, erode quality, and face daunting political hurdles.” </span></span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">The AHA will continue to lead the health care field on affordability and value.&nbsp;The </span></span><span lang="EN" style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">AHA supports new approaches to delivering higher-quality care at lower cost through innovative alternative payment models, as well as </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">efforts to transform the delivery system to ensure the right care happens at the right time in the right setting.&nbsp;</span></span><span lang="EN" style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Today’s health care system is rife with administrative burden. The hospital field faces duplicative regulation and compliance burdens, along with myriad requirements from insurance plans, each of which have different claims processing, recordkeeping and medical necessity requirements. An AHA </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"><a href="" style="color:#0563c1; text-decoration:underline">study</a></span></span><span lang="EN" style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> found that health systems, hospitals and post-acute care providers spend nearly $39 billion a year on administrative costs — costs not associated with the delivery of patient care — to support compliance with federal regulations. The AHA is also advocating for lower drug prices, </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">liability reform, further reducing barriers to communication and collaboration among providers, and improving access to health care coverage, especially behavioral health care, among other things.&nbsp; &nbsp;&nbsp; </span></span></span></span></p> <p><span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,sans-serif"><span style="background:white"><span style="font-family:&quot;Arial&quot;,sans-serif">As we emerge from this epidemic, we should focus on how to bolster hospitals and health systems to prepare them for future pandemics, not layer on more unhelpful regulations. RAND’s omissions and missteps take away from the value this report might otherwise offer in charting a path forward. </span></span></span></span></span></p> <p><span style="font-size:11pt"><span style="line-height:normal"><span style="font-family:Calibri,sans-serif"><i><span style="background:white"><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:#333333">Rick Pollack is president and CEO of the American Hospital Association.</span></span></span></i></span></span></span></p> </div> <div class="field_author"> <span>Rick Pollack</span> </div> <div class="field_topics"> <div><a href="/topics/price-transparency" class="topic" hreflang="en">Price Transparency</a></div> <div><a href="/topics/novel-coronavirus-sars-cov-2covid-19" hreflang="en">Novel Coronavirus (SARS-CoV-2/COVID-19)</a></div> <div><a href="/topics/leadership" hreflang="en">Leadership</a></div> <div><a href="/topics/cost-management" hreflang="en">Cost Management</a></div> </div> <div class="field_type">Blog</div> Fri, 05 Mar 2021 17:33:18 +0000 tjordan_drupal 675969 at AHA Letter to Biden-Harris Transition Team on Price Transparency Rule <span class="title">AHA Letter to Biden-Harris Transition Team on Price Transparency Rule</span> <span class="uid"><span>dsamuels_drupal</span></span> <span class="created">Dec 21, 2020 - 05:39 PM</span> <div class="body"><p>AHA requests&nbsp;the Biden Administration exercise&nbsp;enforcement discretion with respect to compliance with the Centers for Medicare &amp; Medicaid Services’ hospital price transparency final rule requiring hospitals to make public, effective Jan. 1, 2021, all of the rates they negotiate with commercial health insurers.</p> </div> <div class="field_topics"> <div><a href="/topics/price-transparency" class="topic" hreflang="en">Price Transparency</a></div> <div><a href="/topics/regulatory" hreflang="en">Regulatory</a></div> </div> <div class="field_type"> <div>Type</div> <div><a href="/taxonomy/term/113" hreflang="en">Letter/Comment</a></div> </div> <div class="field_access_level"> <div>Access Level</div> <div><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div> <div class="field_paragraphs_text_with_heade"> <div> <div class="paragraph paragraph--type--paragraphs-text-with-headers- paragraph--view-mode--default"> </div> </div> </div> <div class="field_search_promotion"> <div>Search Promotion</div> <div>Not Promoted</div> </div> <h4 class="page-header">Key Resources</h4> <div class="field_related_files file file--mime-application-pdf file--application-pdf"> <div> <article> <div class="field_media_file"><span class="file file--mime-application-pdf file--application-pdf"><a href="/system/files/media/file/2020/12/aha-letter-to-biden-harris-transition-team-price-transparency-rule-letter-12-21-20.pdf" type="application/pdf" title="AHA Letter to Biden-Harris Transition Team on Price Transparency Rule">AHA Letter to Biden-Harris Transition Team on Price Transparency Rule</a></span> </div> </article> </div> </div> <div class="field_archived"> <div>Archived</div> <div>Off</div> </div> Mon, 21 Dec 2020 23:39:39 +0000 dsamuels_drupal 674791 at AHA Outlines Initial Policy Priorities for Biden Administration <span class="title">AHA Outlines Initial Policy Priorities for Biden Administration</span> <span class="uid"><span>dsamuels_drupal</span></span> <span class="created">Dec 11, 2020 - 02:34 PM</span> <div class="body"><p>The Honorable Joseph R. Biden<br /> President-elect of the United States<br /> 1717 Pennsylvania Avenue, N.W.<br /> Washington, DC 2006</p> <p>Dear President-elect Biden:</p> <p>On behalf of the American Hospital Association’s (AHA) nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners – including more than 270,000 affiliated physicians, 2 million nurses and other caregivers – and the 43,000 health care leaders who belong to our professional membership groups, we congratulate you on being elected the 46th President of the United States of America. We share your important goal of quickly and aggressively ending the COVID-19 pandemic, which has tested our country and our health care system like never before. This must be our nation’s highest priority. We stand ready to tackle this daunting challenge together.</p> <p>Our member hospitals and health systems, along with our doctors, nurses and other team members, have been on the front lines of the pandemic, working tirelessly to provide the best care for our patients, families and communities. Given our unique role, we have repeatedly shared publicly the importance of wearing masks, washing hands and practicing social distancing. In addition, we have engaged with local and state officials to assist with testing and contact tracing. Currently, we are gearing up to support widespread deployment and administration of COVID-19 vaccines and therapies. Our hospitals and health systems are deeply committed to collaborating with you and your Administration to tackle these unprecedented challenges and to end the public health crisis.</p> <p>We believe our joint focus should be on providing relief, ensuring a smooth recovery, and rebuilding a better health care system for the future. In addition, we need to address ongoing challenges that have been further exasperated during the pandemic, including issues related to health equity, workforce resilience and behavioral health.</p> <p>This letter outlines a set of priority recommendations that we urge you to implement during your first 100 days in office as they require immediate attention. We will share a&nbsp;more extensive set of recommendations in the new year to help advance health in America.</p> <h3>Relief</h3> <p>To ensure that America’s hospitals can continue to fight the pandemic, we urge your Administration to help ensure they have the resources they need to care for their communities. Hospitals and health systems are projected to lose more than $320 billion in 2020 alone due to COVID-19. They have faced enormous costs to maintain proper personal protective equipment (PPE), ensure adequate supplies and equipment, safeguard sufficient staffing, purchase new drugs and therapies, and retrofit their physical plants to care for patients with the virus. These expenditures come as months of essential hospital revenue has eroded due to the combination of reduced demand for emergent and non-emergent care, as well as growing uncompensated care costs attributable to the newly uninsured. Specifically, we ask your Administration to:</p> <ul> <li>Ensure the extension of the public health emergency, currently set to expire on Jan. 20, 2021, to safeguard needed flexibilities, including critical 1135 waivers, through the duration of the public health crisis.</li> <li>Ensure providers can retain Provider Relief Fund dollars by allowing use of any reasonable method for calculating COVID-19-related lost revenue, movement of targeted distributions within a system, and use of funds for increased staffing costs.</li> <li>Protect vital federal funding for public programs, including stopping unlawful payment cuts that do not recognize legitimate differences among provider settings, also described as site-neutral payment policies.</li> <li>Ensure vital Medicaid financing arrangements, such as provider assessments and intergovernmental transfers, remain available to states through official rescission of the Medicaid financial accountability rule.</li> <li>Protect the 340B drug savings program to ensure vulnerable communities have access to more affordable drug therapies by reversing harmful policies and holding drug manufacturers accountable to the rules of the program, especially as it relates to contract pharmacy arrangements.</li> <li>Require that private plans serving the Medicare, Medicaid and Marketplace programs eliminate administrative and financial barriers to coverage for COVID-19 testing and treatment and ensure that providers are adequately compensated for this care.</li> <li>Rescind provider requirements to publicly disclose negotiated rates that do nothing to help patients understand their costs, could result in anticompetitive actions on the part of health plans, and, according to the Federal Trade Commission, could result in high costs for patients.</li> </ul> <h3>Recovery&nbsp;</h3> <p>As the hospital field moves forward both with caring for COVID-19 patients and safely delivering needed health care services to others, we ask for your help in ensuring that the nation can successfully “coexist with COVID-19.” Critical to this is ensuring patients’ access to care, as the COVID-19 pandemic has only further demonstrated the importance of comprehensive health coverage. Additionally, given the&nbsp;economic downturn, it is more crucial than ever to ensure affordable, high-quality coverage options are available regardless of employment status or income level. Moreover, to spur recovery, we will need to quickly and effectively distribute vaccinations to the American public. We urge your Administration to:</p> <ul> <li>Engage in robust outreach and enrollment efforts to capture the millions of individuals who are eligible for, but not enrolled in, some form of subsidized coverage.</li> <li>&nbsp;Open a special enrollment period for the Health Insurance Marketplaces for the duration of the public health emergency.</li> <li>Eliminate rules that expanded access to health sharing ministries and short-term limited duration coverage products (so called “skinny plans”).</li> <li>Encourage states to extend coverage and care to their populations through innovative state waivers (section 1115 and 1332 waivers) with appropriate safeguards against eligibility reductions and cost-sharing increases.</li> <li>Allow states to delay Medicaid eligibility recertification during the public health emergency.</li> <li>&nbsp;Rescind recent rules that weaken maintenance of effort protections for Medicaid enrollees.</li> <li>Implement a communication effort on vaccine safety, particularly among segments of the population who justifiably mistrust such efforts, and ensure tracking to understand better long-term outcomes and effectiveness.</li> </ul> <h3>Rebuilding</h3> <p>America’s health care system will never be the same due to COVID-19. We need to seize this opportunity to help reimagine a new system that better protects patient access to care, advances affordability, improves quality and patient safety, and truly transforms health care financing and delivery. This includes accelerating movement toward alternative payment systems that increase provider financial stability, as well as create new care models and alternative care delivery sites. We need to explore new staffing models and the innovative use of technology, such as telehealth and remote patient monitoring, to augment care and allow it to move outside the hospital into patients’ homes. Additionally, we need to create a new era of health preparedness, which includes bolstering our public health infrastructure, diversifying the health care supply chain, and reassessing the interaction between federal, state and local governments. We look forward to sharing further thoughts with you in the new year on rebuilding and reimagining the health care system to make it stronger and more sustainable.</p> <h3>Address Ongoing Critical Challenges</h3> <p>The events of 2020 have brought forth a number of vulnerabilities in our health care system, especially those related to health equity, workforce resilience and behavioral health care. Our recommendations in these areas follow.</p> <p><u>Equity:</u> Unequal access to care, disproportionate disease burden and disparities in health outcomes predate the COVID-19 pandemic. However, they have contributed&nbsp;to one of the greatest tragedies this year: the disproportionately high mortality rate from COVID-19 among Black and Latino communities, especially among those serving as essential workers. We urge your Administration to take steps to help make meaningful progress, such as:</p> <ul> <li>Rescind the “public charge” rule that has contributed to disparities in enrollment in health care coverage among Latino and other immigrant communities.</li> <li>Repeal the June 2020 final rule that narrowed the scope of non-discrimination protections under Section 1557 of the Affordable Care Act.</li> <li>Rescind Executive Order 13950, Combating Race and Sex Stereotyping, which has a detrimental effect on diversity and inclusion training in federal agencies, grantees, contractors and beyond.</li> <li>Empower the Secretary of Health and Human Services to lead a department-wide effort addressing health inequities and engage in an inter-departmental effort to address the social and structural determinants of health.</li> </ul> <p><u>Workforce</u>: Recruiting, training and maintaining staff is challenging in the best of times. The surge of COVID-19 cases and the continued need to handle the pandemic has resulted in strain and exhaustion, especially among clinicians. To protect our front-line caregivers, ease workforce shortages and prevent clinician burnout, we urge you to:</p> <ul> <li>Provide support for front-line workers by ensuring child care, housing, PPE and priority access to vaccines.</li> <li>Expanding the physician supervision requirement waiver to include nurse practitioners.</li> <li>Coordinating with the Department of Defense and other relevant agencies to provide direct staffing relief in hard hit communities.</li> <li>Reinstitute critical waiver flexibilities, such as those that halted data collection and in-person routine compliance surveys.</li> <li>Make certain telehealth flexibilities permanent.</li> <li>Support a more diverse and inclusive workforce through clinician education and training efforts and new recruitment initiatives targeted at underrepresented communities.</li> <li>Reduce variability of scope of practice laws to allow caregivers to practice at the top of their license.</li> </ul> <p><u>Behavioral Health:</u> The burden of COVID-19 also will have far-reaching effects on behavioral health. The stress from unemployment, isolation due to quarantine, and grief over loved ones lost to the pandemic are likely to manifest in increases in already high rates of deaths of despair (i.e., suicides and substance use). While hospitals and health systems have been working hard to integrate behavioral health services into physical health care, serious gaps and barriers in insurance coverage and reimbursement have&nbsp;resulted in dire workforce shortages and reduced access to care. It is critical that your Administration address these urgent, nationwide needs by taking steps to:</p> <ul> <li>Enforce the Mental Health Parity and Addiction Equity Act requiring insurers who offer coverage for behavioral health conditions to use comparable standards for those services as for medical/surgical services.</li> <li>Eliminate regulatory barriers to care coordination posed by the restrictions under 42 CFR Part 2, which limit the ability of providers to share important information regarding care and treatment for substance use disorders.</li> <li>Improve the behavioral health workforce by considering additional funding and/or student loan forgiveness to support training for health professionals at all levels to reduce workforce shortages.</li> </ul> <p>On behalf of our members and all of the hospitals and health systems in America, we look forward to working with your Administration to swiftly address the COVID-19 crisis and improve access to high quality care and coverage for all Americans.</p> <p>Sincerely,</p> <p>/s/</p> <p>Richard J. Pollack<br /> President and Chief Executive Officer</p> </div> <div class="field_topics"> <div><a href="/topics/novel-coronavirus-sars-cov-2covid-19" class="topic" hreflang="en">Novel Coronavirus (SARS-CoV-2/COVID-19)</a></div> <div><a href="/topics/access-health-coverage" hreflang="en">Access &amp; Health Coverage</a></div> <div><a href="/topics/disparitiesequity-care" hreflang="en">Disparities/Equity of Care</a></div> <div><a href="/topics/health-insurance" hreflang="en">Health Insurance</a></div> <div><a href="/topics/emergency-readiness" hreflang="en">Emergency Readiness</a></div> <div><a href="/topics/access-behavioral-health" hreflang="en">Access to Behavioral Health</a></div> <div><a href="/topics/workforce" hreflang="en">Workforce</a></div> <div><a href="/topics/disparitiesequity-care" hreflang="en">Disparities/Equity of Care</a></div> <div><a href="/topics/advocacy-public-policy" hreflang="en">Advocacy &amp; Public Policy</a></div> <div><a href="/topics/price-transparency" hreflang="en">Price Transparency</a></div> </div> <div class="field_type"> <div>Type</div> <div><a href="/taxonomy/term/113" hreflang="en">Letter/Comment</a></div> </div> <div class="field_access_level"> <div>Access Level</div> <div><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div> <div class="field_paragraphs_text_with_heade"> <div> <div class="paragraph paragraph--type--paragraphs-text-with-headers- paragraph--view-mode--default"> </div> </div> </div> <div class="field_lead"><p>December 11, 2020</p> </div> <div class="field_search_promotion"> <div>Search Promotion</div> <div>Not Promoted</div> </div> <h4 class="page-header">Key Resources</h4> <div class="field_related_files file file--mime-application-pdf file--application-pdf"> <div> <article> <div class="field_media_file"><span class="file file--mime-application-pdf file--application-pdf"><a href="/system/files/media/file/2020/12/aha-outlines-initial-policy-priorities-for-biden-administration-letter-12-11-20.pdf" type="application/pdf" title="Letter: AHA Outlines Initial Policy Priorities for Biden Administration">AHA Outlines Initial Policy Priorities for Biden Administration</a></span> </div> </article> </div> </div> <div class="field_archived"> <div>Archived</div> <div>Off</div> </div> Fri, 11 Dec 2020 20:34:41 +0000 dsamuels_drupal 674601 at Rand Rebuttal: Facts Are Stubborn Things; Statistics Are Pliable <span class="title">Rand Rebuttal: Facts Are Stubborn Things; Statistics Are Pliable</span> <span class="uid"><span>dsamuels_drupal</span></span> <span class="created">Sep 25, 2020 - 02:12 PM</span> <div class="body"></div> <div class="field_topics"> <div><a href="/topics/price-transparency" class="topic" hreflang="en">Price Transparency</a></div> <div><a href="/topics/cost-management" hreflang="en">Cost Management</a></div> </div> <div class="field_type"> <div>Type</div> <div><a href="/taxonomy/term/105" hreflang="en">Blog</a></div> </div> <div class="field_access_level"> <div>Access Level</div> <div><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div> <div class="field_paragraphs_text_with_heade"> <div> <div class="paragraph paragraph--type--paragraphs-text-with-headers- paragraph--view-mode--default"> </div> </div> </div> <div class="field_lead"><p><span style="font-size:11pt"><span style="line-height:107%"><span style="font-family:Calibri,sans-serif"><span style="font-size:14.0pt"><span style="line-height:107%">Facts Are Stubborn Things; Statistics Are Pliable </span></span></span></span></span><br /> <span style="font-size:14.0pt"><span style="line-height:107%"><span style="font-family:&quot;Calibri&quot;,sans-serif">How RAND Corporation Is Endangering Our High-Value Healthcare Systems by Oversimplifying the Complexities of How the System Works</span></span></span></p> <p><span style="font-size:14.0pt"><span style="line-height:107%"><span style="font-family:&quot;Calibri&quot;,sans-serif">September 24, 2020</span></span></span></p> </div> <div class="field_search_promotion"> <div>Search Promotion</div> <div>Not Promoted</div> </div> <h4 class="page-header">Key Resources</h4> <div class="field_related_files file file--mime-application-pdf file--application-pdf"> <div> <article> <div class="field_media_file"><span class="file file--mime-application-pdf file--application-pdf"><a href="/system/files/media/file/2020/09/rand-rebuttal.pdf" type="application/pdf" title="Rand Rebuttal: Facts Are Stubborn Things; Statistics Are Pliable How RAND Corporation Is Endangering Our High-Value Healthcare Systems by Oversimplifying the Complexities of How the System Works">Facts Are Stubborn Things; Statistics Are Pliable How RAND Corporation Is Endangering Our High-Value Healthcare Systems by Over</a></span> </div> </article> </div> </div> <div class="field_archived"> <div>Archived</div> <div>Off</div> </div> Fri, 25 Sep 2020 19:12:43 +0000 dsamuels_drupal 659720 at Blog: RAND Gets it Wrong (Again) on Hospital Prices <span class="title">Blog: RAND Gets it Wrong (Again) on Hospital Prices </span> <span class="uid"><span>tjordan_drupal</span></span> <span class="created">Sep 22, 2020</span> <div class="field_media_featured_image"><article> <div class="field_media_image"> <img src="/sites/default/files/styles/900x400/public/2020-02/banner-consolidation-2.jpg?itok=G1-xjJRY" width="900" height="400" alt="Consolidation " loading="lazy" /> </div> </article> </div> <div class="body"><p><span style="font-size:11pt"><span style="line-height:107%"><span style="font-family:Calibri,sans-serif">The RAND Corporation has released the third edition of its hospital price transparency study. The AHA previously highlighted our extensive concerns with the data and methodology used in the last version. Now, with supposedly much-expanded data, the authors double down on their pre-conceived conclusions. And, unfortunately, the data and the rigor of the methods still just do not hold up on examination. &nbsp;</span></span></span></p> <p style="margin-bottom:12px"><span style="font-size:11pt"><span style="line-height:107%"><span style="font-family:Calibri,sans-serif">Once again, the study relies on data from a largely handpicked and self-selected sample of employers and insurers. Collectively, the claims included in the study represent just 0.7% of total inpatient admissions and 1.8% of total outpatient visits in the U.S. over the study period.<sup>[<a href="Annual Survey of Hospitals">1</a>]</sup>&nbsp;The authors also tout that they went from 25 states represented to 49 states. However, more than half the states in the study have fewer than 1,000 inpatient services included in the sample for 2018. For example, in New Mexico, there were just 65 inpatient services included in 2018. And although the authors did show some hospital-specific data, the amount of data for most hospitals identified is similarly underwhelming. For two-thirds of hospitals for which inpatient stays are reported, the authors had fewer than 100 inpatient stays over the three year period of the study upon which to draw their conclusions. </span></span></span></p> <p style="margin-bottom:12px"><span style="font-size:11pt"><span style="line-height:107%"><span style="font-family:Calibri,sans-serif">In addition to the limited data set, the central theme – that prices are unchecked – is undercut by trend data at the national level. According to the Centers for Medicare &amp; Medicaid Services, price growth for hospital care services was just 2.4% in 2018, and non-price factors such as intensity of services and inpatient bed days grew slowly as well. These factors combined for historic low growth in hospital spending.<sup>[<a href="">2</a>]</sup>&nbsp;More recent data from the U.S. Bureau of Labor Statistics shows hospital prices have consistently grown less than 3% per year over the last decade and have frequently grown by less than the average rate of inflation. In fact, even when excluding the artificially low rates paid to hospitals by Medicare and Medicaid, annual price growth has still been below 3% in recent years.<sup>[<a href="">3</a>]</sup></span></span></span></p> <p style="margin-bottom:12px"><span style="font-size:11pt"><span style="line-height:107%"><span style="font-family:Calibri,sans-serif">The authors also once again use Medicare payment rates as a benchmark to compare against privately negotiated rates because they make for an “easy comparison.” Yet Medicare knowingly reimburses well below the cost of providing care. In 2018, hospitals were paid only 87 cents for every dollar they spent caring for Medicare patients. The total Medicare payment shortfall was $57 billion in 2018, up from $37 billion in 2014.<sup>[<a href="">4</a>]</sup>&nbsp;If private payers were to adopt Medicare payment rates, it would strip away vital health care resources.&nbsp; </span></span></span></p> <p style="margin-bottom:12px"><span style="font-size:11pt"><span style="line-height:107%"><span style="font-family:Calibri,sans-serif">Hospitals and health systems are open 24/7 and provide treatment for everyone regardless of ability to pay. Their role also increasingly includes providing, often without additional compensation, non-medical social and public health services traditionally provided by state and local governments and caring for communities ravaged by a growing number of severe natural and manmade disasters, such as hurricanes, wildfires and mass shootings. No other part of the health care system has stepped up – and been on the front line – to meet these growing demands. </span></span></span></p> <p style="margin-bottom:12px"><span style="font-size:11pt"><span style="line-height:107%"><span style="font-family:Calibri,sans-serif">The study also relies on Leapfrog scores as a measure of quality, despite their significant limits and flaws. These scores are heavily based on faulty measures calculated from billing data. They use old data that do not reflect more recent improvements in care. The scoring methodology is also unfairly biased against those who do not respond to Leapfrog’s voluntary annual survey. </span></span></span></p> <p style="margin-bottom:12px"><span style="font-size:11pt"><span style="line-height:107%"><span style="font-family:Calibri,sans-serif">It’s also telling that once again the study ignores the role another important set of stakeholders – health insurers and third party administrators -- plays in health spending. There is no discussion of the leverage insurers and third party administrator often have in markets they dominate. This treatment of one of the most costly parts of the health care system may be explained by the study’s reliance on data voluntarily supplied by insurers; under the explicit terms of the data sharing agreements the authors entered into with insurers, “prices could not be compared among or between health plans.” </span></span></span></p> <p style="margin-bottom:12px"><span style="font-size:11pt"><span style="line-height:107%"><span style="font-family:Calibri,sans-serif">We cannot have a serious discussion about our nation’s system of care providers without acknowledging how much has changed during the COVID-19 pandemic. Many hospitals and health systems are now struggling to make ends meet as they continue to care for patients in their community day in and day out. Those already struggling are barely hanging on. It is beyond reckless to cut vital payments to care providers at a time like this, especially with such a faulty rationale as the foundation.</span></span></span></p> <p style="margin-bottom:12px"><span style="font-size:11pt"><span style="line-height:107%"><span style="font-family:Calibri,sans-serif"><i>Aaron Wesolowski is AHA vice president of Policy Research, Analytics and Strategy.</i></span></span></span></p> <p style="margin-bottom:12px">&nbsp;</p> <div> <hr align="left" size="1" width="33%" /> <div id="ftn1"> <p class="MsoFootnoteText"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><a href="#_ftnref1" name="_ftn1" title=""><span class="MsoFootnoteReference" style="vertical-align:super"><span class="MsoFootnoteReference" style="vertical-align:super"><span style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:&quot;Calibri&quot;,sans-serif">[1]</span></span></span></span></span></a> AHA, Annual Survey of Hospitals, 2016-2018</span></span></p> </div> <div id="ftn2"> <p class="MsoFootnoteText"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><a href="#_ftnref2" name="_ftn2" title=""><span class="MsoFootnoteReference" style="vertical-align:super"><span class="MsoFootnoteReference" style="vertical-align:super"><span style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:&quot;Calibri&quot;,sans-serif">[2]</span></span></span></span></span></a> National Health Expenditure Data, 2018. CMS, Office of the Actuary, National Health Statistics Group.</span></span></p> </div> <div id="ftn3"> <p class="MsoFootnoteText"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><a href="#_ftnref3" name="_ftn3" title=""><span class="MsoFootnoteReference" style="vertical-align:super"><span class="MsoFootnoteReference" style="vertical-align:super"><span style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:&quot;Calibri&quot;,sans-serif">[3]</span></span></span></span></span></a> Bureau of Labor Statistics, Producer Price Index Data, Series PCU622 and PCU 62211A.</span></span></p> </div> <div id="ftn4"> <p class="MsoFootnoteText"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><a href="#_ftnref4" name="_ftn4" title=""><span class="MsoFootnoteReference" style="vertical-align:super"><span class="MsoFootnoteReference" style="vertical-align:super"><span style="font-size:10.0pt"><span style="line-height:107%"><span style="font-family:&quot;Calibri&quot;,sans-serif">[4]</span></span></span></span></span></a> AHA, January 2020 Fact Sheet: Underpayment by Medicare and Medicaid.</span></span></p> </div> </div> </div> <div class="field_author"> <span>Aaron Wesolowski</span> </div> <div class="field_topics"> <div><a href="/topics/price-transparency" class="topic" hreflang="en">Price Transparency</a></div> <div><a href="/topics/cost-management" hreflang="en">Cost Management</a></div> </div> <div class="field_type">Blog</div> Tue, 22 Sep 2020 13:11:32 +0000 tjordan_drupal 657062 at Health Insurer Price Transparency Rule That Takes Effect July 1 Could Spotlight Media Attention on Hospitals <span class="title">Health Insurer Price Transparency Rule That Takes Effect July 1 Could Spotlight Media Attention on Hospitals</span> <span class="uid"><span>Matthew Diener</span></span> <span class="created">Jun 23, 2022 - 09:10 AM</span> <div class="body"><div class="container"> <div class="row"> <div class="col-md-8"> <p>The <a href="">transparency in coverage rule</a> takes effect July 1, imposing new transparency requirements on most group health plans and issuers of health insurance coverage in the individual and group markets. The transparency rule does not apply to grandfathered plans and coverage that are not required to comply with all aspects of the Affordable Care Act. Specifically, beginning next month most health plans must disclose publicly in machine-readable files all in-network negotiated rates and out-of-network allowed amounts. The files will need to be updated on a monthly basis.</p> <p>Tech disruptors and hospital critics have signaled their intention to make immediate use of the data to promote through the media their existing advocacy around provider pricing. We also expect the data to be highlighted during price negotiations with employers.</p> <p>Given the significant hospital implications of this data release and subsequent analyses, we recommend hospitals engage their finance, contracting and communications departments to prepare. Below are resources and additional information to help with your preparations.</p> <h2>Register for June 27 AHA Webinar</h2> <p>The AHA will host a members-only webinar June 27 at 2 p.m. ET during which AHA staff and representatives from Deloitte will provide important updates and insights on compliance with price transparency requirements, as well as the implications of the public reporting of hospital prices by insurers. The webinar also will preview upcoming information technology rules that are expected to be issued over the next few months. The webinar is for hospital and health system leaders, as well as members of the IT, communications and finance teams. You can <a href=";_charset_=utf-8">register for the webinar here</a>.</p> <h2>Additional AHA Resources</h2> <ul><li>An <a href="/advisory/2021-10-26-member-advisory-update-federal-price-transparency-policies">updated chart</a> on the status of current federal price transparency policies affecting hospitals and insurers.</li> <li>A <a href="/news/blog/2022-06-16-hospitals-and-health-systems-are-working-implement-price-transparency-policies">blog post</a> on how hospitals and health systems are working to implement price transparency policies and help patients understand costs.</li> <li>A <a href="/costsofcaring">report</a> examining the growth in a variety of input costs of hospitals and health systems, including expenses for workforce, drugs, supplies and equipment, as well as the impact of skyrocketing economy-wide inflation.</li> <li>A patient-focused template video explaining hospitals’ commitment to help make costs understandable. For AHA members who want to use this video and add their own branding, <a href="/system/files/media/video/2020/12/AHA-Price-Transparency-Version-A.mp4">download here</a>.</li> <li><a href="/pricetransparencyrule#patienttools">Tools</a> to examine your price transparency communications to ensure they are patient-centered. The package of resources includes a self-assessment, patient communication infographic and secret shopper exercise.</li> <li>A <a href="/news/perspective/2022-05-20-perspective-rand-40-hospital-pricing-again-misses-mark">column</a> from AHA President and CEO Rick Pollack on how a recent RAND corporation report on hospital prices missed the mark.</li> <li><a href="/issue-brief/2019-09-18-real-affordability-solutions-front-lines-caring">Examples</a> of how hospitals and health systems are leading the way on real solutions to affordability.</li> </ul><h2>What You Can Do</h2> <style type="text/css"> <!--/*--><![CDATA[/* ><!--*/ ul.checklist { list-style: none; text-indent: -15px; } ul.checklist li:before { content: '✓ '; } /*--><!]]>*/ </style><ul class="checklist"><li>Please share this Advisory with your leadership team, as well as your communications, finance and IT teams in advance of the July 1 data release.</li> <li>Prepare in advance for questions from the media about price transparency.</li> <li>Watch for more details and resources from the AHA on this topic.</li> </ul><h2>Key Messages</h2> <p>The AHA developed the following messages to assist hospitals and health systems in preparing for the insurer price transparency rule.</p> <p><strong>Health insurance is complicated. We are here to help.</strong></p> <ul><li>We want to give patients the answers they need about the costs of hospital treatment so they can plan ahead.</li> <li>We recognize some people are facing higher out-of-pocket costs due to high deductibles and other health plan cost-sharing requirements.</li> <li>Patients’ out-of-pocket costs are based on a number of factors, including: <ul><li>Their health insurance plan’s benefit design; and</li> <li>How much of their deductible they have met.</li> </ul></li> </ul><p><strong>Patients deserve the best possible information about what they should expect to pay for a scheduled service.</strong></p> <ul><li>Hospitals and health systems are committed to helping patients access cost estimates.</li> <li>The field is embracing new technologies, like online calculators, that make accessing such estimates easier than ever.</li> <li>Insurers are a key partner in developing patient-specific cost estimates because patient costs will differ depending on their health plan features and cost-sharing requirements.</li> <li>Cost estimates can change as the course of treatment changes.</li> </ul><p><strong>Health care costs vary, and economy-wide factors are driving costs up after years of low growth.</strong></p> <ul><li>Health care costs vary because hospitals and health systems are different in terms of their mission, breadth of services they provide, areas of specialty and the needs of the patients and communities they serve.</li> <li>The dramatic rise in costs of labor, drugs, supplies and equipment, as well as general, economy-wide inflationary pressures, continue to put enormous pressure on the ability of hospitals and health systems to provide care to patients and communities. Despite this, economic data from the Bureau of Labor Statistics show that aggregate hospital prices have risen slower than the rate of inflation recently.</li> <li>These surges in input costs, along with ongoing challenges from the COVID-19 pandemic and Medicare payment cuts, have continued to strain the resources the hospital field needs to care for their patients and communities.</li> <li>Health insurance plans also are contributing to rising health care costs through a variety of policies, many of which are unnecessary and some of which are harmful to patient health and workforce wellbeing. These policies include inappropriate use of medical necessity to delay or deny care, and using prior authorization to delay patient care or discharge.</li> </ul><h2>Further Questions</h2> <p>Please do not hesitate to contact us with any questions regarding this Advisory. You can contact Ariel Levin, director of coverage policy at <a href=""></a>, or Sean Barry, senior associate director of media relations, at <a href=""></a>.</p> </div> <div class="col-md-4"> <p><a href="/system/files/media/file/2022/06/Member-Advisory-Insurer-Transparency-2022-06-23.pdf" target="_blank" title="Click here to download the Member Advisory: Health Insurer Price Transparency Rule That Takes Effect July 1 Could Spotlight Media Attention on Hospitals and Health Systems PDF."><img alt="Member Advisory: Health Insurer Price Transparency Rule That Takes Effect July 1 Could Spotlight Media Attention on Hospitals and Health Systems page 1." data-entity-type="file" data-entity-uuid="ded85905-e674-40ab-b898-48f215219536" src="/sites/default/files/inline-images/Page-1-Member-Advisory-Health-Insurer-Price-Transparency-Rule.png" style="border: solid black 1px;" width="900" height="1164" loading="lazy" /></a></p> </div> </div> </div> </div> <div class="field_media_featured_image"><article> <div class="field_media_image"> <img src="/sites/default/files/2022-06/Page-1-Member-Advisory-Health-Insurer-Price-Transparency-Rule.png" width="900" height="1164" alt="Member Advisory: Health Insurer Price Transparency Rule That Takes Effect July 1 Could Spotlight Media Attention on Hospitals and Health Systems page 1." loading="lazy" /> </div> </article> </div> <div class="field_topics"> <div><a href="/topics/price-transparency" class="topic" hreflang="en">Price Transparency</a></div> </div> <div class="field_type"> <div>Type</div> <div><a href="/advisories" hreflang="en">Advisory</a></div> </div> <div class="field_access_level"> <div>Access Level</div> <div><a href="/taxonomy/term/279" hreflang="en">Member</a></div> </div> <div class="field_lead"><div class="container"> <div class="row"> <div class="col-md-8"> <p><strong>Member Advisory</strong></p> <p>June 23, 2022</p> <p><em>Register for June 27 AHA webinar and view resources and key messages to help with your preparations and response</em></p> </div> <div class="col-md-4"> <center> <div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2022/06/Member-Advisory-Insurer-Transparency-2022-06-23.pdf" target="_blank" title="Click here to download the Member Advisory: Health Insurer Price Transparency Rule That Takes Effect July 1 Could Spotlight Media Attention on Hospitals and Health Systems PDF.">Download the PDF</a></div> </center> </div> </div> </div> </div> <div class="field_search_promotion"> <div>Search Promotion</div> <div>Not Promoted</div> </div> <div class="field_archived"> <div>Archived</div> <div>Off</div> </div> Thu, 23 Jun 2022 14:10:19 +0000 Matthew Diener 684294 at AHA blog: Beware of misguided assessments of hospital price transparency <span class="title">AHA blog: Beware of misguided assessments of hospital price transparency</span> <span class="uid"><span>kpage_drupal</span></span> <span class="created">Jun 16, 2022</span> <div class="field_media_featured_image"><article> <div class="field_media_image"> <img src="/sites/default/files/styles/900x400/public/2018-04/stock-doctor-prescription-bottles_900x400.jpg?itok=hyLuYxKP" width="900" height="400" alt="stock-doctor-prescription-bottles_900x400" loading="lazy" /> </div> </article> </div> <div class="body"><p>“Understanding potential costs is an important part of the patient experience when planning for care, and hospitals and health systems are committed to helping patients navigate that process,” writes Ari Levin, AHA’s director of coverage policy. “…While hospitals press forward to help patients understand their anticipated costs for care, some outside groups are taking this opportunity to mischaracterize what is happening in the field.” <a href="">READ MORE.</a><br /> &nbsp;</p> </div> <div class="field_topics"> <div><a href="/topics/price-transparency" class="topic" hreflang="en">Price Transparency</a></div> </div> <div class="field_type">Headline</div> Thu, 16 Jun 2022 19:36:11 +0000 kpage_drupal 684209 at Hospitals and Health Systems Are Working to Implement Price Transparency Policies and Help Patients Understand Costs <span class="title">Hospitals and Health Systems Are Working to Implement Price Transparency Policies and Help Patients Understand Costs</span> <span class="uid"><span>Matthew Diener</span></span> <span class="created">Jun 16, 2022</span> <div class="field_media_featured_image"><article> <div class="field_media_image"> <img src="/sites/default/files/styles/900x400/public/2022-06/blog-price-transparency-900x400.jpg?itok=JCaXoJVI" width="900" height="400" alt="Hospitals and Health Systems Are Working to Implement Price Transparency Policies and Help Patients Understand Costs. An older man and woman review medical billing on a laptop and on a printout. The man is holding a calculator." loading="lazy" /> </div> </article> </div> <div class="body"><p>Understanding potential costs is an important part of the patient experience when planning for care, and hospitals and health systems are committed to helping patients navigate that process. That is why the field is developing and deploying tools to help patients get the information they need. Hospitals also have policies in place to assist patients who cannot pay for part or all of the care they receive.</p> <p>The AHA is supporting this activity by highlighting tools that aid patients and align with the new federal price transparency policy. The first requirement of the policy includes a provision around “shoppable services” that can be met through the use of a patient cost estimator tool, an approach that has been widely adopted. Hospitals and health systems have been able to increase adoption of these tools due largely to growth in the availability of technological resources at multiple price points and with increased functionality. In particular, this “next generation” of price transparency tools are easier for hospitals to implement and for consumers to navigate.</p> <p>The second hospital price transparency rule requirement, compiling large machine-readable files of all the rates negotiated with health insurers, continues to pose challenges in terms of cost and complexity. These files add little to no direct benefit to patients, who have made clear in their requests to hospitals and health systems that they are most interested to know what they will actually have to pay.</p> <p>Complicating this further was the need for hospitals and health systems to prioritize responding to COVID-19 surges and vaccine administration. These efforts required significant staff time during much of 2021, resulting in further challenge and, in some cases, delays in the publication of machine-readable files.</p> <p>The Centers for Medicare &amp; Medicaid Services (CMS), the federal agency responsible for enforcement, has worked with many AHA members to navigate these challenges and help them achieve compliance. AHA members report appreciating the opportunity to work through these details with CMS in a collaborative way.</p> <p>While hospitals press forward to help patients understand their anticipated costs for care, some outside groups are taking this opportunity to mischaracterize what is happening in the field. These groups ignore CMS’ guidance on aspects of the rule, such as how to fill in an individual negotiated rate when such a rate does not exist due to patient services being bundled and billed together. In this instance, CMS has said a blank cell would be appropriate since there is no negotiated rate to include. In spite of this, some outside groups still count any file with blank cells as “noncompliant.” This is a fundamental misrepresentation of the rules.</p> <p>As a result, these organizations have reached wildly different conclusions about the status of implementation across the hospital field. Patient Rights Advocate, for example, claims only 14% of hospitals are compliant, while a Milliman analysis found a compliance rate of 68%. CMS, the only true arbiter, has indicated about 160 hospitals remain out of compliance, a much smaller number than either the Patient Rights Advocate or Milliman reports suggest.</p> <p>The AHA strongly cautions against buying into misguided “assessments” of hospital compliance with the price transparency rule. Hospitals are working hard to provide accurate financial estimates for patients. This is challenging work and requires consideration of both hospital rates and patients’ health care coverage.</p> <p>We appreciate CMS’ continued commitment to work with hospitals toward compliance, and the AHA will continue to seek opportunities to work constructively and serve as a resource for members and CMS with the goal of getting patients the best possible information.</p> <p><em>Ariel Levin is AHA’s director of coverage policy.</em></p> </div> <div class="field_author"> <span>Ariel Levin</span> </div> <div class="field_topics"> <div><a href="/topics/price-transparency" class="topic" hreflang="en">Price Transparency</a></div> <div><a href="/topics/covid-19-cdc-fda-and-cms-guidance" hreflang="en">COVID-19: CDC, FDA and CMS Guidance</a></div> </div> <div class="field_type">Blog</div> Thu, 16 Jun 2022 17:44:27 +0000 Matthew Diener 684193 at CMS announces first penalties under hospital price transparency rule <span class="title">CMS announces first penalties under hospital price transparency rule</span> <span class="uid"><span>hnesich_drupal</span></span> <span class="created">Jun 9, 2022</span> <div class="field_media_featured_image"><article> <div class="field_media_image"> <img src="/sites/default/files/styles/900x400/public/2018-04/CMS%20Update%20pic.jpg?itok=Jki06v3V" width="900" height="400" alt="CMS Update pic" loading="lazy" /> </div> </article> </div> <div class="body"><p>The Centers for Medicare &amp; Medicaid Services yesterday announced the first civil monetary penalties under its hospital price transparency rule, fining two hospitals for alleged failure to make public their list of standard charges.&nbsp;</p> <p>The rule took effect Jan. 1, 2021. It requires hospitals to disclose the rates they privately negotiate with health plans, as well as their self-pay and charge master rates, and provide an online patient cost estimator tool or negotiated rate information for at least 300 “shoppable” services, or face penalties ranging from $300 to $5,500 per day, depending on the hospital’s size.&nbsp;<br /> &nbsp;</p> </div> <div class="field_topics"> <div><a href="/topics/price-transparency" class="topic" hreflang="en">Price Transparency</a></div> <div><a href="/topics/cost-management" hreflang="en">Cost Management</a></div> <div><a href="/topics/compliance" hreflang="en">Compliance</a></div> </div> <div class="field_type">Headline</div> Thu, 09 Jun 2022 19:06:53 +0000 hnesich_drupal 684111 at