New Proposed Rule to Increase Medical Billing Transparency Open for Public Comment

In January, a new federal law required all U.S. hospitals to publicly post list prices for their medical services online. A new proposed Department of Health and Human Services (HHS) rule wants to take this a step further. The proposed rule would require hospitals to disclose the prices they negotiate with health insurance companies to increase pricing transparency and reduce “surprise” medical bills. The HSS is seeking your comments until May.

The HHS proposed a variety of technology-related health care reforms in its proposal titled, “21st Century Cures Act.” NPR pointed out, however, that among the suggested reforms were two questions related to publicly disclosing more medical price information for consumers, highlighting the need for transparency in health care costs. The HHS also stated it hopes transparent pricing information will help consumers make better health decisions and increase competition to lower prices.

Under the price information section in the 187-page document, the HHS outlines a variety of changes the rule would put in place. This includes provisions such as requiring hospitals to share the entire pricing process, from list price to cost negotiated with a patient’s health plan, including out-of-pocket expenses. It also mandates a tool so you could compare prices ahead of time and information on the cost of emergency services, such as ambulance rides. The proposed rule also states:

Patients and plan sponsors have trouble anticipating or planning for costs, are not sure how they can lower their costs, are not able to compare costs, and have no practical way to measure the quality of the care or coverage they receive relative to the price they pay. Pricing information continues to grow in importance with the increase of high deductible health plans and surprise billing, which have resulted in an increase in out-of-pocket health care spending. Transparency in the price and cost of health care would help address the concerns outlined above by empowering patients to make informed health care decisions.

While, according to NPR, some health care experts aren’t sure the proposed rule would really make a big impact on rising health care costs, the Trump administration sees this as another step to reduce surprise medical billing and give consumers more choice and control over their health care. Other organizations, such as the American Hospital Association, oppose the proposed pricing changes, saying patients only care about their out-of-pocket costs, not the whole pricing system.

The proposed rule, including the price information change, is currently open to public comment. So far, many comments highlight public support for the outlined price transparency changes.

“As long as patients have financial responsibility, prices should be transparent and easily discovered,” one commenter wrote. “We will not transform healthcare in this country until both price and quality become transparent. … There is no rational reason for protecting the current secrecy between carriers and providers when someone else is actually paying the bill.”

“Price transparency is absolutely critical,” another commenter wrote. “I cannot think of another industry where the buyer (patient) has little idea of what they will pay ahead of a procedure. In addition, there is no reason that individuals should pay more than insurance companies for the same procedure. I strongly endorse this new proposed rule.”

If you want to weigh in with your thoughts, visit the HHS proposal page for the “21st Century Cures Act” on Regulations.gov and click on the blue “Comment Now” button in the upper right-hand corner. You’ll be taken to a page where you can type your comment. You don’t have to include your name. Comments are open until 5 p.m. ET on May 3.