That’s awesome. What is the law or rule or order that is requiring this transparency? I know it was something Trump signed (one good thing he did) but was it an executive order or an actual law passed by Congress or something else?
Insurers would still be able to have PPO lists. They wouldn’t depend on special negotiated rates, just on the best fixed rate. Providers would still want the volume that comes from being on those lists.
Because … what, competition will encourage providers to keep costs down and want to maximize volume somehow? I have bad news for you: a huge swath of this country has exactly one choice for health care in its area. Oh sure, maybe you can choose between Doctors A, B, C, D, E and F but they all work for Entity X, which runs the hospital and outpatient clinic. And Entity X owns hospitals R, S, T and U (and probably others) in an area. Did I mention Entity X is “not for profit” which still pays executives hundreds of thousands of dollars each for perfunctory duties, while “making difficult choices” to discontinue servces at S, T and U because of “lack of usage” and “insufficient Medicare payments?”
Where’s their incentive to control costs? There aren’t any. They’re going to squeeze everything they can out of whatever faucet is leaking, and that’s health insurance and individual payers. The pressure to control costs has to come from private insurance, and thus far there’s no sign they’re interested in it.
Yes, out in … the 'po … health care systems are monopolies covering multiple counties. If you get really lucky, you get a choice of two systems. I think I have 2 locally for most stuff; in our prior location, we also had 2 but not the same 2.
What do insurers do? Great question. From what I’ve ever seen, control costs isn’t really one of them. Even ignoring that the billed cost of a normal office visit has gone from $95 to $273 over the last 10 years, my insurer’s payment has gone from $48 to $127 in the same time. The billed cost of an MRI has doubled in the last 5 years; my insurer’s payments has “only” gone up 60%.
Isn’t cost control one of the benefits of Medicare, which providers scream about incessantly because they can’t wring lots of money from the cash cow? I thought that was one of the benefits of single-payer, not just “hooray, everyone gets free health care!”
Don’t even get me started on the misguided notion that health care providers offer “financial counseling” and will “assist people who can’t pay their bill.” They don’t, haven’t for a while, and have zero incentive to do so in the current legal environment - and that’s a huge incentive for them to raise costs.
What amazes me is for those who have the insurance with the higher negotiated rate, their deductible and copays are larger as well.
If the hospital has a negotiated rate of 1200 and your deductible is 2000 with an 80/20 after then you pay 1200 and still have 800 left on your deductible. While if you have the insurance that negotiated 4000 for the same procedure they you pay your 2000 deductible plus 400 coins.
That sucks bigtime. And of course, neither you nor your company knows before hand or after for that matter, what you as the consumer will be paying.
I’d like to see some deeper analysis on this. What I’ve seen so far (NYT) compared a handful of procedures. I wonder if (for example) Aetna is paying more uniformly, or if there is massive variance from one procedure to the next. I used to do some managed care analytics and, generally speaking, the big concern is how the contract performs as a whole with little regard to any individual CPT or DRG or what-have-you.
I suspect payers will scrape the data and try to figure out where they have room to negotiate lower rates. It’s still mostly a matter of who has more leverage in the negotiation, but this could be compelling data for a payer to bring to the table. There’s a lot more ROI in payers doing this than individual patients.