transparency

Medstar Washington Offers Transparency Example for Hospitals

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Dr. Steven Goldstein discussed the spirit of the law that requires hospitals to make their pricing known to the public on his February 5, 2021 podcast, Medstar Washington Offers Transparency Example for Hospitals. You can listen to that podcast by clicking here: Hospital Price Transparency Podcast.

In late 2020, the Department of Health and Human Services issued the final rules on price transparency for healthcare providers. Prior to the release of these new rules, health insurance companies, and healthcare providers like hospitals negotiated prices for all the things they do for patients and did not make any of this information public.

According to Dr. Goldstein what the spirit of these new rules intended and what is happening in practice are not quite the same. As of January 1, 2021, hospitals are required to make prices, those payer-negotiated rates for their services, available online in a readable format.

The big idea here was to make all of those different rates, payer specific rates all more available and more transparent to patients. Sounds easy enough. But, according to the healthcare industry, procedures and services are often not as cut and dried as placing a price tag on a service and charging your insurance.

According to them, some procedures can affect patients differently, causing them to have different levels of care and other needs that all have different prices. Many healthcare providers also cannot say upfront what exactly the price will be, because doctors do not know the extent of the services until they begin offering care.

But there is one shining example of what looks like full compliance. MedStar in Washington posted its prices in an Excel sheet on its website. It is presented in a way that people can see the charges for various procedures from different insurance companies. It looks like what the spirit of these new rules really intended and an example for others to follow.

Some hospital networks haven’t published their price lists yet because they claim they need more clarification from the federal government on how best to translate complex insurance contracts into straightforward prices for consumers.

They also say they are concerned that a lack of standardization in how hospitals approach job of making prices public will make it impossible for people to accurately compare prices between different systems.

Some hospital networks haven’t published their price lists yet because they claim they need more clarification from the federal government on how best to translate complex insurance contracts into straightforward prices for consumers.

They also say they are concerned that a lack of standardization in how hospitals approach job of making prices public will make it impossible for people to accurately compare prices between different systems and honor the law the way that the podcast describes, Medstar Washington Offers Transparency Example for Hospitals.

All that said, Medstar Washington made a credible attempt to comply with the letter and spirit of the law. Hopefully others will follow this example.

Hospital Price Transparency & The Creative Ways Hospitals Find To Avoid Posting Their Prices For The Public

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Lacking transparency
Lacking transparency for hospitals and healthcare.

Some of the most creative writing in business lately are the ‘reasons’ why hospitals and other healthcare providers are not able to post their prices, as the law requires. Respected Houston based neurologist and founder of the Houston Healthcare Initiative, Dr. Steven Goldstein, understands the letter and intent of the new rules on price transparency for healthcare providers and hospitals. Specifically, all the new rules that call for these medical suppliers to essentially post their price list. What the spirit of these new rules intended and what is happening in practice are not quite the same. To hear all of his insights tune to the Houston Healthcare Initiative podcast on SoundCloud, Apple Podcasts, Radio.Com,LibSyn, Spotify, Podcast Addict, iHeartRadio, Stitcher, Backtracks, Podbay, Podbean, and other places where podcasts are syndicated.

Claiming They Do Not Know

The big idea here was to make all of the prices, different rates, payer specific costs charged by insurance companies all more available and more transparent to patients. Sounds easy enough. But, according to the healthcare industry, procedures and services are often not as cut and dried as placing a price tag on a service and charging your insurance. According to them, some procedures can affect patients differently, causing them to have different levels of care and other needs that all have different prices.

Many healthcare providers also cannot say upfront what exactly the price will be, because doctors do not know the extent of the services until they begin offering care. “Hospitals do not want to be pinned down on prices other than to say, ‘it depends’ which is not much of an explanation,” Dr. Goldstein told his audience. “Some hospitals only posted price estimates, uploaded files in difficult to use formats, or promised to release information only after someone enters their insurance information. In New York City, a published investigation found only a handful of hospitals in that city complying while the rest were less than upfront.”

More Reasons To Not Comply

There are other reasons cited for non-compliance. Like the American Hospital Association claim that staff who would help with compliance are stretched thin because of the Covid-19 pandemic. “But the bottom line is that price competition only works if those involved are really competing, Dr. Goldstein said. “Without price disclosure, competition remains very elusive.”

Price Transparency Background

As of January 1, 2021, hospitals are required to make prices, those payer-negotiated rates for their services, available online in a readable format. In late 2020, the Department of Health and Human Services issued the final rules on price transparency for healthcare providers. Prior to the release of these new rules, health insurance companies, and healthcare providers like hospitals negotiated prices for all the things they do for patients and did not make any of this information public. What this arrangement meant was that patients did not know what they would pay for treatment, tests, surgery, drugs and everything else until after they were treated and received the bill. “There is a lot of potential benefit for the American public when or if these rules are fully adopted and made more available for the public,” Dr. Goldstein said.

About The Houston Healthcare Initiative

The Houston Healthcare Initiative (HHI) is a member owned, non-profit medical co-op. Led by Houston based neurologist Dr. Steven Goldstein, the HHI will replace traditional health insurance for qualified individuals and families and provide incentives for members to adopt healthier lifestyle habits. HHI will provide affordable medical coverage through a combination of negotiated rates, low monthly payments, personal accountability and lifestyle incentives. The medical co-op promises to save qualifying individuals and families money on health insurance. At the same time, HHI will help uphold quality care by asking members to bear some responsibility and individual accountability for maintaining their personal health.

 

Hospital Price Transparency Podcast

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Hospital Price Transparency Podcast

How Some Hospitals Are Balking At These New Rules And One That Is Not

This week respected Houston based neurologist Dr. Steven Goldstein will discuss the price’s patients are charged by doctors and hospitals. Specifically, on the new rules about healthcare price transparency. Specifically, on the new rules about healthcare and price transparency. What needed to change on disclosing prices and is anything different as a result? Of course, there are ways that the hospitals are playing around with the information. But there is one shining example of what looks like full compliance.

Child COVID-19 vaccine trials to begin in Florida this week.

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NOTE: Child COVID-19 vaccine trials to begin in Florida this week. Watch how Dr. Steven Goldstein, founder of the Houston Healthcare Initiative, contributed to a major television feature on vaccine trials in the state of Florida. You can see him and the full story here:

WFTV ABC in Orlando, Florida news on Covid-19 vaccine trials.

By: Megan Cruz, WFTV.com and Adam Poulisse, WFTV.com
Updated: October 14, 2020 – 11:45 PM

Child COVID-19 vaccine trials to begin in Florida this week. Starting this week, researchers will begin testing one of the experimental COVID-19 vaccines on children, marking the first trial in the country to do so.

It’s one of several big developments in the race to approve a vaccine.

Screen Shot 2020-10-27 at 4.23.06 PM Child COVID-19 vaccine trials to begin in Florida this week.
In this story Dr. Steven Goldstein discusses liability waivers for vaccine trials starting in the state of Florida.

So far, more than 600 Central Floridians have walked into a DeLand lab, willing to test the Moderna vaccine.

Moderna and Pfizer are in the final phases of testing their vaccines. For Pfizer, that includes testing children 12 and over.

On Tuesday, Johnson & Johnson paused its study after one person got “an unexplained illness.” And it’s been over a month since AstraZeneca’s trial had been put on hold in the U.S. after two British participants experienced neurological issues.

READ: Florida reports 70 new coronavirus-related deaths; almost 3K new cases

When a vaccine is approved and available by, at the earliest, the end of the year, companies cannot be held liable for any unexpected complications. A good place to start with answers is here as Child COVID-19 vaccine trials to begin in Florida this week.

“Now, if there are expected complications, and the company hid that information, like they knew about something that it would happen, and they don’t tell people about it, you can still sue for that,” said Dr. Steven Goldstein of the Houston Healthcare Initiative.

A recent Gallup Poll found people are split right down the middle when asked if they’d take a vaccine, down from the 66% of people who were willing to take it three months ago. People in Florida will help the entire country find answers.

Why Canadian Drug Prices Are Lower Than US Drug Prices

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US & Canadian Drug Prices

What are the reasons prices for prescribed medicine here are far higher than they are in Canada? Is there a good reason or any reason? Add to this the recent federal government action to bring U.S. drug prices close to or on par with their costs in Canada. To make sense of this, please listen to the Houston Healthcare Initiative podcast. Listen here to find out Why Canadian Drug Prices Are Lower Than US Drug Prices.

Listen for more here at https://soundcloud.com/you/tracks.

 

Court Rules Against the Hospital Industry Mandates Price Disclosure

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Court Rules Against the Hospital Industry Mandates Price Disclosure. Hospital prices that were historically rigged by the medical business along with the insurance industry, and kept secret from the public, will see the light of day January 1, 2021. This because on June 23, 2020 a federal judge in Washington D.C. dismissed a suit brought by the American Hospital Association (AHA) that challenged the Department of Health and Human Services rule mandating hospitals to disclose their privately negotiated prices with health insurance companies.  This ruling, and what it means for doctors, patients and the industry, is the subject of the latest edition of the Houston Healthcare Initiative podcast. The Houston Healthcare Initiative podcast can be heard on SoundCloud, iTunes, iHeart, Spotify and on the Houston Healthcare Initiative website.

Court Ruling Allows Transparency

Hospital Price Transparency
Court Rules Against the Hospital Industry & Mandates Price Disclosure.

The court ruled that an executive order from the Trump administration requiring hospitals to disclose pricing was legal. A federal judge upheld a policy that requires hospitals and health insurers to publish their negotiated prices for health services, numbers that are typically kept secret. The policy is part of a major push by the Trump administration to improve transparency in health care. Insurers and health providers usually negotiate deals behind closed doors, and patients rarely know the cost of services until after the fact.

Healthcare Industry Public Relations Offensive

The meaning of the ruling and what will happen are different. As Dr. Goldstein told his audience, “there will be an appeal accompanied by a full court public relations press by the hospital industry to derail this effort.” Dr. Goldstein went on to say, “if the battle can be dragged out until after the presidential election, hospitals and insurance companies can hope a new administration will rescind the executive order.”

Four organizations are now urging the Department of Health and Human Services to delay implementation of the price transparency rule until after the appeals court makes a decision in the case. The American Hospital Association, the Federation of American Hospitals, the Association of American Medical Colleges and the Children’s Hospital Association made their request in a letter to HHS Secretary Alex Azar on June 29, five days after these associations and others filed an appeal against the ruling which would implement a rule on price transparency on January first. The groups said the rule would ‘pose a burden to hospitals and health systems responding to the COVID-19 public health emergency.’ Thirty-four hospital groups have already urged HHS to delay the start of the price disclosure.

In an article published in “Becker Hospital Review” AHA General Counsel Melinda Hatton said, “the proposal does nothing to help patients understand their out-of-pocket costs.” She added, “it also imposes significant burdens on hospitals at a time when resources are stretched thin and need to be devoted to patient care. Hospitals and health systems have consistently supported efforts to provide patients with information about the costs of their medical care. This is not the right way to achieve this important goal.”

About The Houston Healthcare Initiative

Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America. Court Rules Against the Hospital Industry Mandates Price Disclosure.

What The Court Ruled About Hospital Price Transparency

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This week on the Houston Healthcare Initiative podcast, Dr. Steven Goldstein takes a deeper dive into a court decision where hospitals must reveal private negotiated rates with insurers starting this coming January 1, 2021. Plus, he will provide more insight into how hospitals decide what and how much to charge us, and man is that a story. It’s all more than a little complex. The podcast is available on all the popular podcast networks including SoundCloud, iHeart, and Spotify among others.

How Are Prices Now Assessed

Hospital prices are not based on the free market. Instead, prices are agreed on via secret agreements between hospitals and insurance companies. The truth is that pricing for medical services as paid by insurance companies are artificially set and not competitive at all. Prices are agreed to in advance by the hospital and the insurance company, not disclosed to the public. “We are led to believe that our insurance providers negotiate on behalf of their policyholders,” Dr. Goldstein told his audience. This is not the case. The court has ruled that this will no longer be permitted, that hospitals will have to reveal these negotiated rates and thus hospitals must reveal private negotiated rates .

Hospitals must reveal private negotiated rates to the public.
Hospitals must reveal private negotiated rates to the public.The court ruling that upheld a Trump Administration policy that forces hospitals to reveal their prices.

Why Hospitals Object

One reason many hospitals do not list their actual prices is that, according to them, some cases are more complicated than others. “An appendectomy may go smoothly or may be complicated by other factors such as adhesions from a previous surgery that caused scarring,” Dr. Goldstein said. “This may require additional operating room time resulting in a higher cost.  Thus hospitals claim they can only give estimates.”

Alternatively, this could be handled in one of two ways. 1). Publish the price for each procedure at what the hospital perceives as the average price. Then find ways to cut costs so that average cost is lowered resulting in increased profit for the hospital.  2). Alternatively, publish a price for operating room time by the hour that would include all the ancillary charges + publish the range of operating room times for each procedure.

How Prices Are Set Now

With the use of computer technology, hospitals are able to establish a charge for each product or service, no matter how small. “Every aspirin, every blood test, every x-ray, every bandage, every suture has a charge; Dr. Goldstein said. “Some of these charges beg credulity e.g. the $20 aspirin. All these charges are added up to give the total hospital charge. Of course, this doesn’t include multiple physician charges that are separate.” This all resulted in the Trump administration’s order that hospitals must reveal private negotiated rates to the public.

But the final charge is the “sticker price”. The insurance companies never pay this price. They have a secret, negotiated price based on the Medicare price for those services.

Secret Revealed on Pricing Practices of Health Insurance Companies & Hospitals

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The actual price of what a medical test, procedure, exam and often prescription cost and how charges are assigned is not based on the free market. Instead, prices are agreed on via secret agreements between hospitals and insurance companies. This is the subject of the Houston Healthcare Initiative podcast with Dr. Steven Goldstein. To hear the Houston Healthcare Initiative podcast, please visit: SoundCloud, Apple Podcasts, iHeart, PlayerFM, or the Houston Healthcare Initiative web site. Secret Revealed on Pricing Practices of Health Insurance Companies & Hospitals.

Pay More Attention

Price Transparency
Price transparency from insurance companies and medical companies is a rare thing.

Most people get health insurance from their employer which is the reason, so few pay much attention to the price of the medical services and pharmaceuticals that Americans purchase. Employer funded insurance pays for most of what is charged with individuals picking up a smaller deductible. But according to neurologist Dr. Steven Goldstein, it is past time to start devoting attention to not just what is charged but how the health insurance companies, and the medical community decides what to charge and why. Spoiler Alert: it is not based on the free market.

The idea that pricing for medical services as paid by insurance companies are artificially set and not competitive at all. They are agreed to in advance by the hospital and the insurance company, not disclosed to the public, and we are all led to believe that our insurance providers were negotiating on behalf of the people that pay the premiums.

It Is Expensive But…

The fact that the charges for visits to the doctor, hospital and pharmacist are mostly paid for by employer funded insurance does not make us any less likely to get both overcharged and underserved. It is a lack of transparency that makes medical costs so high. It was not wrong to believe that research, new equipment, and pharmaceutical discovery were what was behind the increase in healthcare prices; they account for some. “The issue is that patients do not know the actual price of services,” Dr. Goldstein told his listeners. “The list price is the price charged to patients without insurance. Each insurance company negotiates a discounted price.”

Thus, there are multiple discounted prices depending on the insurance company plus a different price for Medicare and Medicaid. These prices have traditionally been secret. There is no competition between hospitals based on price. “Medicare sets the price standard based on costs,” he said. “Thus, hospitals are cost plus operations with little incentive to reduce costs.”

Why Not Just Pay Cash?

Cash prices are often much less than what is charged even to the insurance companies. People often can secure better deals if they don’t use their insurance. A 2016 Wall Street Journal investigation found that hospitals frequently offer far better deals for people who pay in cash rather than use their insurance. “Price transparency allows individuals to shop for the best nonemergency deal. It would also force hospitals to compete, thus saving consumers money. It gives them a choice,” Dr. Goldstein said. The way any of us chooses to spend our money is the most democratic thing anyone can do.

Price transparency allows individuals to find the best non-emergency deal. It would also force hospitals to compete, thus saving consumers money. “If prices were known, posted in public, people could shop for the non-emergency services,” Dr. Goldstein said.

About Houston Healthcare Initiative

Dr. Steven Goldstein is a Houston based neurologist. He founded the Houston Healthcare Initiative and is an advocate for common sense solutions to the healthcare crisis that confronts the citizens and residents of the United States of America.Secret Revealed on Pricing Practices of Health Insurance Companies & Hospitals