The year 2019 has started with a landmark healthcare headline: a federal mandate is requiring hospitals to post their full pricing lists online.
This is a tremendous amount of data about care costs that has traditionally remained obscured from patients receiving that care.
Back in 2010, the ACA required that these pricing lists be available to the public. But until now, hospitals were not required to actually publish them openly online.
The new mandate took effect as of January 1. Hospitals in your city might have already posted their pricing documentation, generally called chargemasters, on their website.
The changes continue to move the industry in the direction of better price transparency, a value that is one of our cornerstones at Captiva Benefit Solutions.
Notably, this is likely to cut back on balance billing, which is what happens when patients are saddled with making up a (sometimes sizable) difference between what their insurance paid and the cost of service.
However, this step is just that: a step. And many more steps will be required to fully realize a transparent healthcare market.
Although making price listings available en masse is a good start, the reality is that hospitals are only publishing the costs for each service as they stand before insurance companies negotiate the cost down.
This means that prices online don’t match what consumers are likely to pay. Even for those who are uninsured or underinsured, usually some measure of negotiation happens, with chargemasters operating as a starting place.
Equally problematic is the fact that because most hospitals operate on a model that emphasizes volume of care over value, for a patient to get an actual estimate of their care from the online data would require piecing together multiple small procedures: every blood draw, every test, every different doctor who consulted in the process.
These factors have already caused customer confusion in the earliest days of the policy’s enactment. Even the individual names of services can be difficult to decipher for the average person, which further reinforces the need for bundled payments.
Although legislation is moving towards the transparency the healthcare industry sorely needs, it’s clear that it’s moving there very slowly.
The good news is that the problems presented by this legislation are issues that Captiva has already been helping business owners and their employees solve.
Bundled payments solve the challenge of working out a care grand total. Reference based pricing removes dependence on unreliable chargemaster data. Employers taking an active role in educating employees on their care options cuts back on confusion.
Are you ready to stop waiting on broad scale legislation to catch up to the needs we already know exist? Find out more about how your business can benefit from Captiva’s approach.