Price Transparency: It’s Just What the Doctor Ordered

December 4, 2020
Marni Jameson Carey

New HHS rules could cure what ails doctors, too

The clock is counting down not only to a New Year, but also to a new era in health care, one that will be far healthier for patients and doctors. On January 1, the first of two landmark health-care price transparency rules issued by the Dept. of Health and Human Services will go into effect. This one requires hospitals to put their cash and secret negotiated prices online in an easy-to-access format. Soon consumers will be able to see prices up front, and shop for the best value before they get blindsided by a bill they could not see coming.

The second rule, set to take effect Jan. 1, 2022, will require insurance companies to also disclose their secret contracted rates. Together, these rules could rapidly fix our broken health-care system.

Once consumers can see prices beforehand, they will be able to shop for health care the way they shop for clothes, or cars or groceries. Price competition will enter the market causing prices to drop dramatically making care and coverage more affordable. Lower costs will also lead to better access and more choice.

Less obvious than the many consumer benefits of health-care price transparency are the equally significant benefits to physicians.

Although doctors are often blamed along with hospitals and insurance companies for the high and hidden prices of health care, doctors aren’t the problem. Most doctors are on the patients’ side. They want price transparency, too.

Doctors want to be able to tell patients the price of their care, but they often don’t know either. Most doctors don’t set their prices. Hospitals, insurance companies and the government tell doctors what they’ll get paid.

However, come January, when hospitals have to start posting their prices or pay a fine, market pressure will cause them to bring their prices down. They may have to reduce their administrative glut. They also may have to lose their appetite for buying up independent doctors and turning them into employed physicians ― a common practice that dramatically raises prices and burns out doctors. When hospitals own medical groups (and by extension their patients) they leverage their increased market power to get higher payments from insurers.

They also, thanks to deals they’ve struck with Congress, get to layer in facility fees, bill-padding charges that add zero value that independent doctors don’t charge. These fees can drive up the cost of care five-fold.

When health-care prices are finally transparent, consumers will realize that choosing an independent doctor is far less expensive than going to one employed by a hospital, health system or private-equity group. Price transparency will also expose facility fees bringing them into question and ideally extinction. As patients’ value-driven choices steer them toward independent practices, fewer will choose to get care from more expensive hospital outpatient settings.

Buying up medical practices will become less lucrative for hospitals and private equity groups, and, thus, market monopolies will unwind. Health-care consolidation, a leading driver behind soaring health-care costs, will slow as hospitals find it more profitable to release their employed physicians from their contracts and let them practice autonomously again.

Physician burnout among employed doctors will lessen. Most doctors don’t like having an administrator with half the formal education telling them which knee replacement device to use, how many stents to place a week, and how many patients to admit to the hospital per quarter. Yet that is what happens when they become employees. Transparency could help unleash them from their binding contracts.

When independent practices begin to increase and flourish, doctors will once again get back to practicing medicine their way, without quotas and middle players.

For patients, price transparency is their ticket to greater financial certainty. For doctors, it’s their ticket to professional freedom.

Only one obstacle stands in the way. Although more than 90 percent of Americans surveyed want price transparency, not everyone does. Those who profit excessively from the system as it is ― hospitals and insurance companies ― prefer to keep patients and doctors in the dark. Not surprisingly, they are working overtime to block the government’s health-care price transparency rules from taking effect, or to water them down so they’re meaningless.

We can’t let that happen.

Complete health-care price transparency will empower consumers, lower prices, usher in competition, reverse consolidation, help doctors remain or become independent, reduce physician burnout, and restore the doctor-patient relationship.

But we must make sure the new administration continues to enforce these bold bipartisan moves that the current administration set in motion, and does not let the powerful health-care lobbies derail them.

As the New Year begins, along with a new era in Washington, let’s work to ensure that the Biden Administration stands strong behind these price transparency rules and sets our ailing country on a positive path toward unity and healing.

Marni Jameson Carey is the executive director of the Association of Independent Doctors (www.aid-us.org), a national, nonprofit, nonpartisan trade association based in Winter Park, Florida, working to stop health-care consolidation and lower health-care costs.