Trump renews order to reveal health care prices but consumers hardly use it : Shots

It is the holy grail of health care. It forces the industry to reveal prices negotiated between health plans and hospitals. And among the gusts of the executive order signed during the first five weeks of President Trump’s inauguration, there was a promise to “make America healthy again” by giving patients accurate medical prices.

The goal is to make it easier for hospitals and health insurance companies to compare the actual prices of medical procedures and prescription drugs. Trump has given power through the end of May, coming up with standards and mechanisms to ensure that the healthcare industry is compliant.

But Trump’s order in 2025 is also a symbol of how far the country has progressed since he published it. Similar orders Almost six years ago. Consumers find it only partially useful, and the quality of the information is uneven.

The first step in offensive “bold”

He said the 2019 order was “pretty bold.” Gary Claxtonsenior vice president of KFF, a health information nonprofit organization that includes KFF Health News. “They basically went to the provider and the plan and said, “I think all this data you think is a secret that we won’t be confidential anymore.” “

There was a disappointment for consumer advocacy groups after that. Hospitals and insurance companies are listed on their websites and have a huge, complicated and confusing data on prices. This information is a challenge for even medical pricing experts to navigate, let alone consumers. Some members of the council Submitted law To place the power of law in price transparency requirements. Those bills died. And President Joe Biden’s administration was criticised for not enforcing the regulations even more tightly by a single consumer advocacy group Super Bowl Ads It features rapper fat jaw “Hospitals and insurance companies are hiding prices.”

Trump’s new order, signed in February, said hospitals and health plans were “not well maintained when price transparency data is incomplete or not posted at all.”

Government Accountability Bureau Reported in October The Centers for Medicare and Medicaid Services did not know whether the prices reported by the healthcare industry were correct or complete. However, the CMS, which regulates hospitals, now plans to “systematically monitor compliance” and will help agencies understand the requirements, said Katherine Howden, the agency’s spokesman.

Howden did not answer questions about whether CMS staff oversee price transparency compliance.

“Zombie” rates and other contradictions

Meanwhile, independent researchers have discovered many issues with the quality of price data shared by both hospitals and health insurance companies with consumers.

a Recent Reports Data reported by four New York City health insurance companies from Peterson-KFF Health System Tracker often includes the price that these healthcare providers say they will pay hospitals for services they don’t provide or can’t provide. These are called “ghosts” or “zombie” rates. For example, according to the Health Plan, dentists, optometrists and auditors reported being paid for knee replacements, gastrointestinal tests and other procedures not related to their specialty.

Otherwise, the data included different prices for the same services paid by the same insurance company in the same hospital. UnitedHealthCare, for example, reported that it would pay three New York Presbyterian/Weill Cornell Medical Center fees ($47,000, $64,000 and $70,000) to treat a heart attack.

Or the insurance company reported that they would pay the same price for very different services. For example, Aetna said he paid just $6,292 to Sinaibes Israel Hospital for treatment of respiratory infections, heart attacks, gastrointestinal cancer, kidney and urinary tract infections, and psychosis.

Neither UnitedHealthcare nor Aetna addressed the data inconsistencies. UnitedHealthcare spokesman Cole Manbeck said the insurers met price transparency requirements and encouraged members to “use cost estimation tools for accurate costs based on a specific health plan.” Aetna spokesman Shelly Bendit introduced the question to Aphe, a lobbying and trade association for insurance companies.

AHIP spokesman Chris Bond said health insurance companies are “strongly supporting” price transparency. The group said it will work with the Trump administration to provide transparency that “promotes competitive private markets in ways that make sense for end users.”

What should consumers do?

He said the estimate and total price is not very useful to consumers who are primarily interested in what they have to pay from their pockets in the end. David CutlerProfessor of applied economics at Harvard University. Depending on your deduction amount, out-of-pocket and other fees, it depends on your health plan.

“Most of the price transparency information doesn’t have that,” he said.

It also does not provide consumers with information on the quality of care, Cutler added. “When you go to a restaurant it’s like wine,” he said. “People think more expensive wine is better.”

Cutler said he was skeptical that price transparency would reduce costs for patients. However, he said it may provide insight into hospitals and health plans about what competitors are billing and paying for services. Knowledge that incorrectly leads to price increases when hospitals receiving lower fees than their competitors request a higher refund from their health plans.

Trump’s Recent Presidential Orders Note that the top quarter of the most expensive medical services prices has fallen 6.3% per year since orders in 2019.

However, the same study mentioned in the executive order showed that the lowest quarter of services became more expensive at around 3.4% per year. analysis Turquoise Health is a healthcare pricing data company that has surveyed prices in over 200 hospitals in 10 US markets.

Some patients say that research and persistence allowed price transparency to work for them.

Teresa Schmotzer, 50, of Goodyear, Arizona, said she used it. Hospital price data Last year, to save about $3,000 on outpatient surgery to remove uterine fibroids.

Schmotzer, who has health insurance, said the hospital first told her that she was owing $3,700 for the procedure. But she was skeptical.

She said her health insurance company cannot quote the price of the procedure or specify how much she owe. On the morning of the surgery, Schmotzer said he found a spreadsheet online at PatientRightSadvocate.org, which includes different prices paid by insurance companies, including her. The reported price for the procedure is close to $700, she said.

Schmotzer said she took the printout of the spreadsheet to the hospital and presented it in advance. She paid the $300 deduction and told the hospital to charge her for the rest.

A few months later, she said the bill was delivered by mail for the remaining $400 she paid.

When people go for surgery, it causes fear when they don’t make it clear in advance what the cost is, she said. “Because they’re blind.”

Next Steps

The hospital says them Ariel Levin, director of the American Hospital Association coverage policy, representing approximately 5,000 agencies, said he would like to work with federal regulators to comply with reporting requirements. Levin said consumers should give them a “more comprehensive estimate” that describes the price of the service and the entire episode of care and how much they will pay from their pocket based on their health plan.

Since Trump’s 2019 order, CMS has been developing rules to make it easier to understand the pricing information reported by hospitals and health plans. The agent has fined More than 12 hospitals for failing to comply.

Federal Rules I’ll allow the hospital To report a service estimate, price range, or historical rate, Health Plan Prices can be adjusted based on factors such as case severity, duration of treatment, and patient age.

KFF’s Claxton said this flexibility doesn’t allow “apple-app comparisons” and that the data must be trusted before researchers can use it to better understand medical costs. “It doesn’t seem to be that way yet,” he said.

He said there is a lot to do before we can meet expectations that price transparency will increase competition and reduce costs. Katie MartinCEO of the Healthcare Cost Research Institute, a non-profit research group.

Price transparency alone isn’t a silver bullet, Martin said. This is an “important first step” to help employers, lawmakers, regulators and others understand how to flow through the healthcare system and how to make it more efficient. “That’s not the whole thing.”

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