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Kaiser Health News reported on CMS's finalization of its Hospital Price Transparency Requirements. Hospitals will need to publish a list of services, their prices, and a range of negotiated discounts. CMS will specify 70 services that hospitals will need to publish data for, and hospitals themselves can select another 230.
An earlier version of this policy required hospitals to not only publish insurance discounts, but also how much each discount would be for each insurance company (and perhaps plan). That would have been more useful to consumers so that they can more accurately assess how much they would likely be liable for given their specific plan. Nevertheless, this policy is still a step in towards pricing transparency.
Kaiser Health News also noted the proposal to require insurers to offer financial calculators to their members, which would be another welcome change.
Health System Tracker, a collaboration between the Peterson Center on Healthcare and Kaiser Family Foundation, published an interesting piece on longer-term trends of healthcare spending among employees of large employers in the US in August. Unsurprisingly, healthcare spending (through both insurance premiums and out-of-pocket spending) has been increasing year after year. In 2008, the average total healthcare spending for a family of four was close to $15,000, while in 2018, the figure almost reaches $23,000 (representing a 55% increase). During the same time period, workers' wages grew by about 25%. In terms of absolute dollars, employees are not seeing all of the increases since their employers have been paying more and more via premiums, just as the employees have been. Similarly, average annual health spending by individual with larger employer coverage has increased from around $3,700 to over $5,700. Elsewhere, people have argued that the increase in spending is mostly due to rising prices, not more consumption of healthcare services.
Most of the increases in out-of-pocket spending appears to be coming through deductibles, at the expense of copayments. If the absolute dollar figure for copayments remains relatively static (e.g. $35 per visit), it would make sense that the percentage of out-of-pocket spending through deductibles has increased dramatically. However, in other news, Kaiser Health News reports that many employers are planning to scale back their reliance on high-deductible plans -- when the economy does well, employers are more likely to be generous with benefits such as health insurance.
Bloomberg published an editorial reporting that House Speaker Pelosi has proposed legislation to limit how much Medicare pays for medications. Under current laws, Medicare is prohibited from negotiating drug pricing. The new legislation would like to limit Medicare's price for medications to 1.2 times the average price paid in certain other industrialized countries. In cases where a drug is not sold internationally, Medicare would like to receive the same pricing that state Medicaid programs receive.
This legislation seems unlikely to pass in the current political climate. However, the editorial pointed out that Congress's assessment is that even with the pricing limits in place, pharmaceutical companies would likely continue their pace of drug discovery, albeit modestly slower (2%-5% less than current efforts, versus the dramatic fallout often claimed by industry).
For at least the past several years, Medicare has been pushing the idea of value-based payments, where instead of paying doctors for procedures, it would pay doctors for patients' health. The idea is that there are some actions that physicians can take earlier on to prevent patients' health from deteriorating to a point that would require expensive procedures. Under the old payment model, doctors generally lacked the financial incentive to perform those preventative measures (which were arguably often undervalued). With the new payment model, the theory is that providers could do better financially if their patients stayed healthier. Last month, The New York Times published a piece that took a look back over the last several years to see if Medicare's shift in payment model made a difference. Unfortunately, the answer appears to be not much difference (one study concluded "no effect from financial incentives of the program on quality of care or patient satisfaction"), perhaps saving "a modest amount of money."
The piece linked to a number of studies to support the overall conclusion. However, it seems like there is insufficient research to conclude whether the entire approach is ineffective (e.g. impossible to create good metrics) or whether it is just the implementation that is flawed (e.g. too little incentive or too many goals in too short of a time).
Another article on the theme of surprise medical bills: Kaiser Health News published a piece earlier about people who might be lobbying against protections from surprise medical bills. While some physicians have objected to at least part of such protections, the authors of the article indicate that some private equity firms have much to lose if protection from surprise medical bills is legislated, but that those firms are employing lobbyists who do their work seemingly on behalf of physicians.
It is unclear whether the current arrangement gives physicians too much power (which might be the case if physicians largely do not feel the need to enter into network contracts because the alternative is more profitable). It might be that large insurers could start a campaign of only contracting with provider facilities that either do not employ out-of-network physicians or that agree to cover the difference between the cost of those physician services and the cost of in-network services. Presumably, such contractual arrangements would result in higher short-term prices, but would probably result in savings over the long run (and probably much more palatable to patients).