Hospital Price Transparency: Is the Juice worth the Squeeze?

Last week, RAND issued its latest assessment of hospital prices concluding…

“In 2022, across all hospital inpatient and outpatient services (including both facility and related professional claims), employers and private insurers paid, on average, 254% of what Medicare would have paid for the same services at the same facilities. State-level median prices have remained stable across the past three study rounds: 254 %of Medicare prices in 2018 (Round 3), 246%in 2020 (Round 4), and 253% in 2022 (Round 5—the current study).”

Like clockwork, the American Hospital Association issued its “Rebuke” of the report:

“In what is becoming an all too familiar pattern, the RAND Corporation’s latest hospital price report oversells and underwhelms. Their analysis — which despite much heralded data expansions — still represents less than 2% of overall hospital spending. This offers a skewed and incomplete picture of hospital spending. In benchmarking against woefully inadequate Medicare payments, RAND makes an apples-to-oranges comparison that presents an inflated impression of what hospitals are actually getting paid for delivering care while facing continued financial and other operational challenges.

In addition to the ongoing flaw of relying on a self-selected sample of data, their analysis is suspiciously silent on the hidden influence of commercial insurers in driving up health care costs for patients….”

It’s the 5^th Edition of RAND’s Employer Transparency Report, each featuring slight methodology changes using Sage Transparency Commercial Claims Data developed for the Employer Forum of Indiana.

The debate over hospital prices is not new nor is RAND the only investigator. Since the Trump administration enacted its Executive Order 13877 (Improving Price and Quality Transparency in American Healthcare) June 24, 2019, numerous organizations have introduced price transparency tools to enable hospital price shopping i.e. Turquoise, Milliman, Leapfrog et al. The Biden administration continued the rule increasing its penalties for non-compliance and Congress has passed 3 laws with bipartisan support widening its application. However, best-case results reflected as articulated by Larry Levitt, senior vice president of the Kaiser Family Foundation, have not been realized:

“App developers will go crazy developing shopping tools for patients, and patients will use those tools to search for the best deals. The public availability of prices will shame high-priced hospitals into lowering their prices because they’ll be so embarrassed.”

My take:

Academic researchers and economists have concluded that hospital price transparency has not led to reduced heath spending overall nor lower hospital prices. Per a recent systematic review: “No evidence was found for impact on the outcomes volume, availability or affordability. The overall lack of evidence on policies promoting price transparency is a clear call for further research… Price-aware patients chose less costly services that led to out-of-pocket cost savings and savings for health insurers; however, these savings did not translate into reductions in aggregate healthcare spending. Disclosure of list prices had no effect, however disclosure of negotiated prices prompted supply-side competition which led to decreases in prices for shoppable services.”

Per Wall Street Journal actuaries, hospital price increases account for 23% of annual health spending increases but vary widely based on factors other than their underlying costs. Determining how hospital prices are set remains beyond the scope of conventional pricing models.

Nonetheless, hospital price transparency is here to stay: public attention is likely to grow and sources– both accurate and misleading– will multiply. It’s safe for elected officials because it’s popular with voters. Per Patient Rights Advocate survey (December 2023), 93% of adults think hospitals should be required to post all prices ahead of scheduled services. It’s clearly seen as foundational to the Federal Trade Commission doctrines of consumer protection and competition. And it’s important to privately insured consumers—the majority of Americans– since 73% of their claims are for “shoppable services” though they trust payers more than hospitals for estimates of their out-of-pocket obligations in these transactions (61% vs. 22%).

In July 2018, I wrote:” Arguing price transparency in healthcare is a misguided effort is like arguing against clean air and healthy eating: it’s senseless.” It’s still true. Making the case that price transparency has a long way to go based on current offerings and utilization is legitimate. The price transparency movement is gaining momentum in healthcare: though it still lacks widespread impact on spending today, it soon will.”

Hospitals are 30% of total U.S. health spending and almost 40% of the population uses at least one hospital service every year. Promoting “whole person care,” while touting quality war while disregarding affordability and price transparency for consumers seems inconsistent. Enabling consumers to easily access accurate prices—not just out-of-pocket estimates– is imperative for hospitals seeking long-term relevance and sustainability. And state and federal lawmakers, along with employers, should structure benefits that reward consumers directly for shopping discipline instead of allowing insurers to benefit alone.

Is the Juice worth the Squeeze for hospital price transparency efforts? To date, proponents say yes, opponents say no, and each side has valid concern about use by consumers. But unless one believes the role of consumers as purchasers and users of the system’s service will diminish in coming years, the safe bet is hospital price transparency will play a bigger role.

Paul

PS: Last Wednesday, U.S. Sens. Sheldon Whitehouse (D-RI) and Bill Cassidy, M.D., (R-LA) introduced a bipartisan bill, the Pay PCPs Act (S. 4338), to improve pay for high-quality primary care providers. The Pay PCPs Act would task the Centers for Medicare & Medicaid Services (CMS) to develop hybrid payments to reward primary care providers who provide the best care to their patients—care that reduces patients’ emergency visits, hospitalizations, excess specialist services and other big cost drivers. The bill would provide Medicare beneficiaries with reduced cost-sharing for certain primary care activities and service and would also create a new technical advisory committee to help CMS more accurately determine Fee Schedule rates.

Resources

Quotables

Re: April 2024 hospital price increases: “One reason U.S. inflation is still high: Increases in prices for procedures to prop open clogged arteries, provide intensive care for newborns and biopsy breasts. Hospitals didn’t raise prices as early in the pandemic as supermarkets, retailers and restaurants. But they have been making up ground since then. Their increases have contributed to stubbornly high inflation readings from the consumer-price index, which in April increased 3.4% from a year ago.

Hospital prices specifically jumped 7.7% last month from a year ago, the highest increase in any month since October 2010…For patients and their employers, the increases have meant higher health-insurance premiums, as well as limiting wage hikes.

The CPI for hospitals is largely a measure of prices for privately insured and cash-paying patients. It also includes Medicare outpatient prices… Hospitals sat out the first waves of inflation that swept through the economy in recent years, though not by choice. Their prices were locked in under contracts with health insurers, for more than a year in some cases. As hospitals have renegotiated prices, inflation has taken hold. That is because hospitals have demanded higher prices from commercial health insurers to pay for soaring wages for nurses and other workers. Hiring and openings in healthcare have remained strong even as employment in other industries has slowed. ..

Hospital price increases are responsible for about 23% of the growth in U.S. health spending each year, on average, according to an analysis by federal actuaries for the Journal. Health-insurance premiums last year shot up at the fastest rate in a decade…

Businesses owners in some cases are seeking to pass those costs on to their customers, which could add to pricing pressure economywide. “

Surging Hospital Prices Are Helping Keep Inflation High – WSJ

Re: surprise medical bills: “…Millions of Americans face unforeseen out-of-pocket expenses, but few can shoulder such a burden. This contributes to medical debt or time out of work for medical issues being a factor in 66% of all bankruptcies in the U.S. My personal experience builds on a national discourse regarding the imperative for enhanced transparency in healthcare pricing and safeguarding patients from the specter of surprise medical bills…

Surprise medical bills… often stem from patients unwittingly receiving care from out-of-network providers, resulting in substantially higher costs that insurance fails to cover. These bills impose financial burdens on patients, precipitating stress and anxiety over the daunting prospect of affording necessary medical care. According to a study published in the New England Journal of Medicine, nearly one in five in emergency department visits yields out-of-network charges…

The opacity surrounding healthcare pricing makes it difficult for patients to ascertain the cost of their care upfront, engendering bewilderment, frustration, and financial distress when confronted with unexpected bills. Although the No Surprises Act (NSA) was passed to address just this issue, its implementation (beginning in 2022) has been contentious and some hospitals are still not in compliance…”

I’m a Former Surgeon General and I Couldn’t Believe My $10k Medical Bill | MedPage Today

Re: Kocher on General Catalyst’ acquisition of Summa Health: “The experiment could be a “disaster… Whenever you tell a doctor to change something, they say no and they say it’s going to harm somebody somehow. Hospitals have remained remarkably unchanging because we’re scared of hurting people. I think they’re going to arrive and realize it’s a lot more complex and you have to be more careful and you can’t break things…You have to be really careful.”

Bob Kocher, Venrock Capital at STAT’s Breakthrough Summit on Thursday. Venture capitalist Bob Kocher on the state of digital health (statnews.com)

Re: Integrating health and social services in CA: “Gov. Gavin Newsom is spearheading an ambitious $12 billion experiment (CalAIM)to transform Medi-Cal into both a health insurer and a social services provider, one that relies not only on doctors and nurses, but also community health workers and nonprofit groups that offer dozens of services, including delivering healthy meals and helping homeless people pay for housing.

These groups are redefining health care in California as they compete with businesses for a share of the money, and become a new arm of the sprawling Medi-Cal bureaucracy that serves nearly 15 million low-income residents on an annual budget of $158 billion.

In addition to in-home asthma remediation, CalAIM offers 13 broad categories of social services, plus a benefit connecting eligible patients with one-on-one care managers to help them obtain anything they need to get healthier, from grocery shopping to finding a job.”

California’s $12 Billion Medicaid Makeover Banks on Nonprofits’ Buy-In – KFF Health News

Re: employer legal risk with workforce benefits: “An emerging legal battle over workplace health insurance could empower employees to fight back against high costs and put new pressure on their employers.

Why it matters: Workers fed up with rising health care costs are filing lawsuits aiming to hold employers accountable for cutting what they say are bad deals with firms that manage their health benefits.

The heightened legal threat is contributing to employers’ efforts to take a harder line with health insurers, pharmaceutical middlemen and other benefits administrators.

The big picture: Roughly 70% of large employers that offer health insurance are self-insured, meaning they collect premiums from enrollees and pay claims themselves, while often hiring a health insurer or pharmacy benefit manager to oversee benefits.

These companies have been required to ensure they aren’t wasting workers’ money on overpriced health coverage for a few years, but this year they began facing a new federal mandate to attest as much. But employers have said firms managing their benefits often aren’t transparent, making it difficult to know if they’re being responsible stewards of workers’ dollars.”

Employers facing rising health care costs get tough on providers (axios.com)

Re: public health status eroding: “Where Americans live, their health status and a range of socioeconomic factors increasingly determine their experience with the health care system, and in many cases that experience appears to be getting worse. Affordability, while critical, isn’t synonymous with access. Long wait times for doctor appointments, crowded emergency departments, complicated insurance requirements and a dearth of local providers are all making things tougher on patients. For many people, whether they can get the care they need when they need it seems to come down to the luck of the draw.”

U.S. health care is increasingly like a casino (axios.com)

Re: Unpaid Caregiving: “It is the queen of caregivers herself, Alexandra Drane, CEO of Archangels, who is actively doing something about it….It is such an overwhelming issue: caregiving poses a huge financial burden for individuals, with the average unpaid family caregiver working 20 hours a week and spending roughly $7,200 a year on caregiving-related costs. But more than the cost, caregivers need flexibility at work and support, according to a new S&P Global and AARP survey of 1,200 full-time and part-time employees. And while there are more digital health care apps to support caregivers popping up (check out Uber Caregiver and Brain CareNotes), so much more needs to be done to address this overwhelming issue.”

Julie Barnes Maverick Health Policy www.maverickhealthpolicy.com May 17, 2024

Re: International comparisons: “The American health care debate needs a reboot. We must move beyond the arguments that have dominated the discourse for decades and instead look to the successful approaches of other countries. We can achieve universal coverage, invest in public delivery systems, and broaden our understanding of health care to include preventive services, public health initiatives, and the social drivers of health. These will make more of a difference than a simple change to a single-payer system.

By learning from other countries, we can build a better, more inclusive health care system that accomplishes enough for all while allowing some the choice to pay for more. But to do that, we need to have a better conversation — one that is informed, nuanced, and open to new ideas.”

Rethinking Health Care from Global Perspective: American Complexity | Commonwealth Fund

Re: supply chain costs: “The U.S. has imported $14.9 billion in medical equipment in 2024, compared with $14 billion at this time last year, according to the Census Bureau. Chinese imports of syringes, medical masks, respirators and gloves will see higher tariffs, although the size of the increases and when the hikes will take effect vary. Syringes and needles, which currently carry no tariff, will be taxed at 50% this year. Also, this year, the tariff on respirators and face masks will increase to 25%, from a current range of 0 to 7.5%. The tariff on rubber medical and surgical gloves will increase to 25% in 2026, from the current 7.5%.”

What Biden’s tariffs on Chinese medical supplies mean for industry | Modern Healthcare

Re: Healthcare AI oversight: “Federal agencies are grappling with how to oversee AI since President Joe Biden issued an executive order instructing them to last October. FDA Commissioner Robert Califf has previously said the agency doesn’t have the personnel to adequately police advanced AI in health care, since it’s constantly learning and evolving, unlike drugs or medical devices. The senators’ AI roadmap also calls for $32 billion per year in funding for research and development into AI innovation across agencies, including at the National Institutes of Health, the country’s premier funder of health research.”

Senators take a step toward AI oversight – POLITICO

Re: Weight loss drug cost projection: Over the past thirty years, U.S. prescription drug spending has skyrocketed. Spending on prescription drugs jumped from just $47 billion in 1992 to $406 billion in 2022—a 764% increase. Higher prescription drug spending already poses an extraordinary burden on the American people, who are forced to pay higher premiums, taxes, and out-of-pocket costs. Now, spending on prescription drugs is on the verge of increasing like never before. New drugs for diabetes and weight loss like Novo Nordisk’s Ozempic and Wegovy could be potential game changers for the millions of Americans with diabetes and obesity. But these drugs will not do any good for the millions of patients in America who cannot afford them. Further, the outrageously high prices of these drugs have the potential to bankrupt our entire health care system. Today, Novo Nordisk charges Americans with type 2 diabetes $969 a month for Ozempic, while this same exact drug can be purchased for just $155 in Canada, $122 in Italy, $71 in France, and $59 in Germany. Meanwhile, Novo Nordisk lists Wegovy for $1,349 a month in the U.S. while this same exact product can be purchased for just $186 in Denmark, $137 in Germany and $92 in the United Kingdom.

Novo Nordisk’s prices are especially egregious given a recent report from researchers at Yale University that found that these drugs can be profitably manufactured for less than $5 a month… Per the model created by the Senate Committee on Health, Education, Labor, and Pensions (HELP Committee) Majority Staff:

If half of Americans with obesity took weight loss drugs, it would cost $411 billion annually.
If half of all Medicare and Medicaid enrollees with obesity took weight loss drugs, it would cost the government $166 billion every year.
Weight loss drugs could raise total annual prescription drug spend by Americans to $1 trillion.
If Wegovy was sold in the U.S. for the same price as it is in Denmark ($186 a month), the U.S. healthcare system could save up to $317 billion dollars annually if half of adults with obesity took the drug. Medicare and Medicaid could save $128 billion per year under those conditions.

Senate HELP Committee Majority Report “Breaking Point: How Weight Loss Drugs Could Bankrupt American Health Care”

Hospitals

RAND Study: Hospital price variation: “This study uses 2020–2022 medical claims data from a large population of privately insured individuals, including hospitals and other facilities from across the United States, to allow an easy comparison of hospital prices Findings:

Prices varied significantly by state.In 2022, states (5) with commercial prices averaging below 200% of Medicare prices were Arkansas, Iowa, Massachusetts, Michigan, and Mississippi. Washington’s relative prices appeared significantly lower in the previous round of this study (Round 4), mainly because some Medicare Advantage claims were erroneously included in that round from Washington’s APCD dataset. That error has been corrected in the current version of this study. States (7) with commercial prices averaging above 300% of Medicare were California, Florida, Georgia, New York, South Carolina, West Virginia, and Wisconsin.
Employers and private insurers paid about 2.5 times what Medicare would have paid for the same services in the same hospital in 2022.Across all hospital inpatient and outpatient services (including both facility and related professional claims), employers and private insurers paid on average 254 % of what Medicare would have paid for the same services at the same facilities. Relative prices for inpatient hospital facility services averaged 255% of Medicare prices; outpatient hospital facility services averaged 289%; and all associated professional services (inpatient plus outpatient) averaged 188% of what Medicare would have paid for the same services.
State-level median prices have remained stable across study rounds, at about 2.5 times higher than Medicare.Changes in the composition of data contributors could introduce changes into the study sample and lead to differences in prices across the five study rounds, but median prices were 254 % of Medicare prices in 2018 (Round 3), 246% in 2020 (Round 4), and 253% in 2022 (Round 5, the current study).
Prices for common outpatient services performed in ASCs averaged more than 1.7 times Medicare prices (170%).However, because of differences in Medicare payment models between ASCs and hospital outpatient departments (HOPDs), prices would have averaged approximately 107% of Medicare prices if paid using Medicare payment rates for HOPDs.
Commercial insurance prices for select administered drugs received in a hospital setting averaged 278 % of average sales price (ASP), if weighting each state’s prices equally, compared with 106% of ASP paid by Medicare.
Most variation in prices is explained by hospital market power.Very little is explained by each hospital’s share of patients covered by Medicare or Medicaid.

Prices Paid to Hospitals by Private Health Plans: Findings from Round 5 of an Employer-Led Transparency Initiative | RAND

Study: CMS’ Star Rating Methodology: In this cross-sectional study of 3076 hospitals that received a star rating in CMS Hospital Compare 2023, presence of the peer grouping step resulted in 585 hospitals (19.0%) being assigned a different star rating than if the peer grouping step was absent, including considerably more hospitals having a higher star rating (517 hospitals) than a lower star rating (68 hospitals).

“Hospital characteristics associated with a higher star rating included urbanicity (351 hospitals [67.9%]), non–safety net status (414 hospitals [80.1%]), and fewer than 200 beds (287 hospitals [55.6%]). Collectively, the presence of the peer grouping step supports a like-to-like comparison among hospitals and supports the ability of patients to assess overall hospital quality.”

Calculation of Overall Hospital Quality Star Ratings with and Without Inclusion of the Peer Grouping Step | Health Policy | JAMA Network Open | JAMA Network

Rural hospitals status: Studies by Chartis and others paint the bleak picture for rural hospitals. According to a recent estimate by the nonprofit Center for Healthcare Quality and Payment Reform, about 700 rural hospitals are at risk of closing. A recent Chartis report estimated 167 rural hospitals have closed since 2010, with another 418 vulnerable to closure now. According to CHQPR, the median margin on patient services at small rural hospitals is about minus 7%. The median overall operating margin for independent rural hospitals is 2.2% in the red.

Medicare Advantage enrollment surged in rural communities by 48% from 2019 to 2023, with 35% of Medicare-eligible patients in those areas joining the private plans. At the same time, the data show that while temporary pandemic relief shored up hospital finances during some of that span, the percentage of rural hospitals operating at a loss rose from 43% to 50% in the 12 months before the Chartis report was released in March.

According to AHIP’s data, each percentage-point increase in Medicare Advantage penetration in rural counties was associated with a 4% lower risk of hospitals closing. It did note, however, that there was still relatively little Medicare Advantage penetration among patients at critical access hospitals, which are smaller. Chartis’ data, which is more recent, finds small hospitals becoming less stable. Miller noted the problems are most acute at those small hospitals, while larger rural facilities are in better financial condition.”

Rural hospitals facing low Medicare Advantage pay risk closing | Modern Healthcare

KLAS Report: Epic widens market lead over Cerner, Meditech: Epic Systems was the only electronic health record vendor to increase its market share in 2023, according to a new KLAS report. The Verona, Epic added 45 organizations and 153 hospitals. Oracle Health lost 71 hospitals and 24 organizations and Meditech lost 12 hospitals. WI-based Epic increased its total market share to 39% of acute care hospitals and 52% of acute care beds. In 2022,

Epic widens EHR market share lead over Cerner, rivals: report

Physicians

Study: Bundled Payment methodology flaw: “The Bundled Payments for Care Improvement Advanced Model (BPCI-A), a voluntary Alternative Payment Model for Medicare, incentivizes hospitals and physician group practices to reduce spending for patient care episodes below preset target prices. The experience of physician groups in BPCI-A is not well understood. We found that physician groups earned $421 million in incentive payments during BPCI-A’s first four performance periods (2018–20). Target prices were positively associated with bonuses, with a mean reconciliation payment of $139 per episode in the lowest decile of target prices and $2,775 in the highest decile. In the first year of the COVID-19 pandemic, mean bonuses increased from $815 per episode to $2,736 per episode. These findings suggest that further policy changes, such as improving target price accuracy and refining participation rules, will be important as the Centers for Medicare and Medicaid Services continues to expand BPCI-A and develop other bundled payment model. Together, our findings suggest that target spending prices were mis calibrated for both hospital and physician group practice participants, and they highlight the nearly deterministic effect of target prices on financial rewards and penal-ties both in BPCI-A and in episode-based payment models more generally.”

Physician Group Practices Accrued Large Bonuses Under Medicare’s Bundled Payment Model, 2018–20 | Health Affairs

Bolstering Chronic Care through Physician Payment: Current Challenges and Policy Options in Medicare Part B May 17, 2024 051723_phys_payment_cc_white_paper.pdf (senate.gov)

JAMA Study: Primary Care Spending in the US by State: The OHSU-AAFP research team assessed states’ primary care spending levels. Findings:

9 states reported estimates of primary care spending as a percentage of total health care spending. Maine, Utah, Virginia, and Washington used different narrow definitions of primary care; their estimates ranging from 3.1% to 6.1% of total spending. Maryland, Maine, Virginia, Utah, and Washington used broader definitions of primary care with ranges from 5.6% to 10.2% of total spending. Connecticut, Massachusetts, Vermont, and Colorado did not define primary care as narrow or broad; their estimates ranged from 5.1% to 10.3% of total spending.

10 states estimated primary care spending by payer type. All 10 provided estimates for commercial payers, and some provided estimates for Medicaid, Medicare Advantage, and Medicare Fee-for-Service. Oregon, Colorado, Vermont, and Maine reported higher percentages of primary care spending across payer types. Colorado and Oregon included behavioral health clinicians (BHCs) in their numerator (primary care expenditures), and Colorado, Massachusetts, and Oregon did not include prescription drugs in their denominator (total health care expenditures).

States had similar intentions to base spending estimates on activities of primary care clinicians. States included family medicine, general pediatrics, general internal medicine, and adolescent

Incomplete or missing data in state reports and lack of clarity and consistency regarding the decisions required to operationalize a measurement of primary care spending limit the ability to make comparison across estimates and to evaluate how differences in estimating decisions might affect the spending estimate. A standard definition of primary care spending and a transparent way of documenting state-specific decisions is essential for monitoring and improving primary care investment. Standardization will enable policymakers and researchers to understand better how primary care spending is affected by new policies and incentives and, ultimately, how this spending is associated with health outcomes.”

Measuring Primary Care Spending in the US by State | Health Policy | JAMA Health Forum | JAMA Network

Private equity dropped from USAG lawsuit: Last week, the U.S. District Court for the Southern District of Texas Monday dropped private equity firm Welsh, Carson, Anderson & Stowe (WCAS) from the Federal Trade Commission’s lawsuit against U.S. Anesthesia Partners, which it acquired in 2012. The owner was dismissed from the suit as the court said there was not evidence to show beyond a reasonable doubt that the firm was behind the alleged monopolization of practices in Texas.

FTC-USAP lawsuit: Welsh, Carson, Anderson & Stowe dropped | Modern Healthcare

Healthcare court win for PE bolsters roll-up strategies – PitchBook

Commonwealth: State of Primary Care in the U.S.:

Percentage of U.S. adults with a regular doctor or place of care: 87%
Percentage of adults who have a regular doctor or place of care and have been with them for five years or more: 43%

Percentage of primary care physicians who reported:

“High” telehealth use: 2%
Making home visits “frequently” or “occasionally”: 29%
Having after-hours arrangements: 52%
They or other personnel in their practice “usually” screen or assess patients for at least one social need: 32%
At least one “major” challenge^ in coordinating their patients’ care with social services: 63%
Their practice was “well” or “somewhat” prepared to manage care for patients with behavioral health needs: 91%

Commonwealth Fund, Finger on the Pulse: The State of Primary Care in the U.S. and Nine Other Countries, March 2024

Polling

Patient Rights Advocate re: Hospital Price Transparency: This survey of 1,130 national adults was conducted December 13th through December 14th, 2023 by the Marist Poll sponsored by the Patient Rights Advocate, Inc.

“Thinking about the 2024 Congress, do you think passing a law that ensures healthcare consumers have access to transparent pricing by requiring hospitals and insurance companies inform consumers of the actual prices upfront should be:

A top priority for Congress: 33%
Important but not a top priority: 59%
Not a priority at all:8%
Unsure: 1%

“Do you think that allowing consumers to know the actual prices and have the ability to compare costs of medical treatments and services upfront is very likely, likely, not very likely, or not likely at all to result in lower costs for consumers on their healthcare services?

Very likely/likely: 78%
Not very likely/not likely at all: 22%

	Strongly agree/ agree	Strongly disagree/ Disagree
“Healthcare organizations such as insurance companies, hospitals, and doctors, should be legally required to disclose all of their prices, including discounted prices, cash prices, and insurance negotiated rates across hospitals and across plans in an easily accessible place online to allow for easy shopping for healthcare services.”	94%	6%
“In general, do you strongly agree, agree, disagree, or strongly disagree with the following statement: Hospitals should be required to post all actual prices in advance of planned care, not just estimates.	93%	7%
“In general, do you strongly agree, agree, disagree, or strongly disagree with the following statement: If I could see the actual prices in advance of care and access actual prices of the competition, and see a fair price, I would shop for the best quality of healthcare at the lowest possible price.”	91%	9%
“In general, do you strongly agree, agree, disagree, or strongly disagree with the following statement: I support hospitals being required to honor their actual price quote provided before care and have their bill clearly match the agreed upon price.	92%	8%
In general, do you strongly agree, agree, disagree, or strongly disagree with the following statement: Allowing consumers to see the actual prices of healthcare services and shop online across the country for health care will lead to more competition between providers and between health plans, which would lower your co	91%	9%

Patient_Rights_Advocate_Inc._National_Survey_2024.pdf (squarespace.com)

Jarrard Consumer Survey re: Physician selection, use: “Insurance, convenience and good reviews matter most when thinking about choosing a PCP: Whether looking for a PCP or a specialist, well over 80% of people say that finding a provider who accepts their insurance is very important or important. Beyond those table stakes, though, about 70% said that a convenient location is important for finding a provider, with just over half giving strong credence to good online ratings and reviews.

That said, among the 80% of survey respondents who have an established PCP, a third found their doctor through a recommendation from a trusted friend or family member. Comparatively, about a quarter found their PCP through a “doctor finder” list from their insurance plan.

Healthcare consumers are in a transitional moment with digital tools: Over half of the people surveyed have used an app or website to schedule a medical appointment in the past year. At the same time, half say that, if all options were available, they would prefer making a phone call to schedule or cancel routine appointments.”

2024 Strategic Positioning Consumer Survey Request – Jarrard Inc

Regulators

CMS extends Medicaid waivers to 2025: On May 9, CMS notified states it will extend flexibilities designed to help states keep more eligible individuals enrolled in Medicaid through June 2025. The waivers, previously set to expire at the end of 2024, will be extended for six more months

As of May 10, 21.9 million people have been disenrolled from Medicaid since April 2023.

CMS has approved 398 total waivers across 52 states designed to increase the number of ex parte, or automatic, renewals, facilitate renewals for disenrolled members, and other uses. Uptake varies by state, with South Dakota requesting just one waiver, and Indiana and Tennessee requesting 15 each.

cib050924-e14.pdf (medicaid.gov)

BLS: April CPI Report: The consumer-price index, a gauge for goods and service costs across the U.S. economy, rose 3.4% in April from a year ago, the Labor Department said Wednesday. Core prices that exclude volatile food and energy items climbed 3.6% annually, the lowest increase since April 2021. The medical care index rose 0.4% in April after rising 0.5% in March. The index for hospital services rose 0.6% over the month, and the index for physicians’ services increased 0.1%. The prescription drugs index rose 0.2 % in April.

Consumer Price Index Summary – 2024 M04 Results (bls.gov)

Federal Trade Commission FY2025 Budget: FTC Chair Lina Khan is asking the House Appropriations Subcommittee on Financial Services she would like to increase its budget next year by about 25% to $535 million to add 55 more staffers.

Republicans on the committee questioned the need for FTC to receive more money, suggesting they would not agree. They also accused Khan’s agency of overstepping with some of its actions. Several complained about the rule banning noncompete clauses in employment contracts, which is facing legal challenges and is opposed by many healthcare employers, though some committee Democrats praised the rule.

Subcommittee Chair David Joyce (R-Ohio), said the proposal “could be well intentioned, but in reality, goes too far, and has the potential to stifle economic growth.”

Medicare Advantage rate cut for 2025 finalized in CMS rule

Hospital Price Transparency: Is the Juice worth the Squeeze?

Previous PostThe Do’s and Don’ts of Navigating the Health System when you Need It: My First-Hand Experience

Next PostHospitals at a Crossroad: Reactive Navigation or Proactive Orchestration?