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U.S. Senate Committee Considers Role of Transparency in Addressing Health Care Costs

September 19, 2018

In the fourth hearing in a series exploring how to reduce health care costs, the U.S. Senate Health, Education, Labor and Pensions (HELP) Committee dedicated attention to the role of transparency in lowering health care spending and empowering patients. 

Throughout the summer months, as part of this “Reducing Health Care Costs” series, the HELP Committee held hearings on the topics of: 

Next week, the committee will hold a fifth hearing to consider how to improve affordability through innovation. 

The Chairman of the HELP Committee, Lamar Alexander (R-TN), framed the hearing this week as “an opportunity to learn how we can improve what information is easily available about the cost and quality of health care, so patients can make the best health care decisions for them, their families, and their wallets.”

Testimony by The Leapfrog Group, Healthcare Bluebook, the Washington Health Alliance, and St. George Surgical Center presented about a variety of topics, including:

  • Perspectives from large purchasers of health care and health care providers
  • Consumer-facing tools that provide information on price and quality
  • Stakeholder alliances that are coordinating public reporting of data, including leveraging an All Payer Claims Database

Attention on the affordability of care for patients and the costs shouldered by health care purchasers, including the federal government, has prompted ongoing discussion about policy avenues to drive down costs. 

All segments of health care—pharmaceuticals, insurers, and providers—are under pressure to increase transparency with respect to both price and quality. 

The Administration has identified transparency as a fundamental policy pursuit and:

  • Is leveraging all available regulatory and policy avenues to make health care information more available and accessible to consumers
  • Has sought input from stakeholders through formal “requests for information” on ways to enhance transparency

In a June letter, the American Hospital Association provided specific input to Centers for Medicare & Medicaid Services (CMS) about how to better assist patients in accessing pricing information for health care services.  

Some targeted examples of recent policy activity include:

  • In the recently finalized inpatient payment rule, CMS established a requirement that, as of January 1, 2019, hospitals must make available, via the Internet in a machine readable format, a list of their current standard charges, updated least annually.
  • The Administration continues to implement the ”American Patients First” blueprint—a comprehensive plan to bring down prescription drug prices and out-of-pocket costs and pursue greater transparency surrounding drug prices. For example, the Senate passed an amendment, supported by the Administration, that would require that direct-to-consumer prescription drug and biological product advertisements include an appropriate disclosure of pricing information.
  • Over the past few weeks, both the House and Senate have advanced legislation that would prohibit health plans from restricting a pharmacist's ability to inform enrollees when a drug would cost less without using their insurance. Some health insurance contracts prevent pharmacists from informing patients when the cash price for their prescription costs less than their insurance cost-sharing arrangement unless the individual asks. 
  • Recently, a bipartisan group of Senators that sit on the committees with jurisdiction over health care programs established a U.S. Senate health care price transparency working group and have proposed draft legislation to protect patients from surprise medical bills. The draft bill is intended to start discussions in Congress about how to address the use of balanced billing whereby a patient is charged for emergency treatment or treatment provided by an out-of-network provider at an in-network facility.

Collectively, health care stakeholders who are part of the health care delivery system—including insurers, physicians, and other providers—must work together to help consumers:

  • Navigate the complex health care delivery system
  • Access sufficient information to make the best choices about their health care and care for family members

Pennsylvania hospitals and health systems have demonstrated a commitment to transparency through initiatives such as HAP’s Care in Pennsylvania web portal, which helps consumers make more informed decisions about their care. In addition, HAP-member hospitals and health systems are working to ensure that consumers have a better understanding of their financial responsibilities and how to get help meeting those responsibilities if needed. 

For more information on HAP’s work to promote greater transparency, please contact Jolene Calla, Esquire, HAP’s vice president, health care finance & insurance. Questions pertaining to federal advocacy may be directed to Laura Stevens Kent, HAPs vice president, federal advocacy.

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