Is Health Price Transparency at Its Tipping Point?

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Is it a coincidence that a number of uninsured consumers filed separate lawsuits in federal courts against Laboratory Corporation of America and Quest Diagnostics—alleging, in both cases, that they were overcharged for clinical laboratory tests—just months before the federal government published final rules requiring hospitals and other providers to publish their prices?

Last month, the federal Centers for Medicare and Medicaid Services (CMS) issued a final rule that is proving unpopular with the hospital industry. It is titled, “Calendar Year (CY) 2020 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS-1717-FC)” and is scheduled to become effective on Jan. 1, 2021.

Both developments have the potential to change the way patients and consumers expect clinical laboratories and anatomic pathology groups to make their lab test prices easy to find and easy to understand.

Today, tens of millions of Americans have high-deductible health plans (HDHPs). These individuals are responsible for annual individual and family deductibles of as much as $5,000 and $10,000, respectively, or more. For them, knowing the price of a medical service or clinical laboratory test in advance of service is essential because they know they have to come up with the cash to pay their share of what may be a large percentage, even 100%, of the lab test or medical treatment.

The current leadership at CMS is determined to advance price transparency. In the press release announcing the final hospital price transparency rule, CMS Administrator Seema Verma said, “Under the status quo, healthcare prices are about as clear as mud to patients … we are throwing open the shutters and bringing to light the price of care for American consumers … Today’s rules usher in a new era that upends the status quo to empower patients and put them first.”

It probably did not escape the notice of many pathologists and clinical lab administrators that the hospital industry voiced strident opposition to this rule. Experts predict that hospitals will file lawsuits to overturn or temper this final rule on price transparency. However, it’s likely these actions will only slow down the current trend toward full price transparency.


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