Home 5 Clinical Diagnostics Insider 5 Sampling of Initiatives to Improve Price Transparency (goes with Inside the Diagnostics Industry article)

Sampling of Initiatives to Improve Price Transparency (goes with Inside the Diagnostics Industry article)

by | Feb 19, 2015 | Clinical Diagnostics Insider, Diagnostic Testing and Emerging Technologies, Inside the Diagnostics Industry-dtet, Legislation-dtet, Reimbursement-dtet

While early efforts to improve transparency in health care costs are targeting hospitals, expect the trend to continue to include laboratory test information as well. Federal The Department of Health and Human Services released for the first time data sets with county-level Medicare spending and utilization information, including comparisons of the charges for the 100 most common inpatient services and 30 common outpatient services. The Health Care Price Transparency Promotion Act of 2013, introduced in the U.S. Congress, proposes that state Medicaid plans should require disclosure of information on hospital charges and provide individuals with information about estimated out-of-pocket costs for health care services. Possible expansion of Medicare’s Hospital Compare Web site to include not only quality metrics, but also price data. Potentially requiring health plans participating in the health care marketplaces under the health care reform law to be more transparent. State Action According to Catalyst for Payment Reform, 34 states currently require reporting of hospital charges or reimbursement rates and more than 30 states are pursuing legislation to enhance price transparency in health care. Among these efforts: In August, North Carolina passed legislation requiring hospitals to provide public pricing information on 140 medical procedures and services. California, New […]

While early efforts to improve transparency in health care costs are targeting hospitals, expect the trend to continue to include laboratory test information as well. Federal
  • The Department of Health and Human Services released for the first time data sets with county-level Medicare spending and utilization information, including comparisons of the charges for the 100 most common inpatient services and 30 common outpatient services.
  • The Health Care Price Transparency Promotion Act of 2013, introduced in the U.S. Congress, proposes that state Medicaid plans should require disclosure of information on hospital charges and provide individuals with information about estimated out-of-pocket costs for health care services.
  • Possible expansion of Medicare’s Hospital Compare Web site to include not only quality metrics, but also price data.
  • Potentially requiring health plans participating in the health care marketplaces under the health care reform law to be more transparent.
State Action According to Catalyst for Payment Reform, 34 states currently require reporting of hospital charges or reimbursement rates and more than 30 states are pursuing legislation to enhance price transparency in health care. Among these efforts:
  • In August, North Carolina passed legislation requiring hospitals to provide public pricing information on 140 medical procedures and services.
  • California, New Hampshire, Maine, Florida, Maryland, Oregon, and New Jersey have launched Web sites to view and/or compare data regarding hospital charges.
According to the APCD Council, nine states operate mandatory “all-payer claims databases” (APCDs), three states are currently implementing mandatory APCDs, and two states have voluntary APCDs. These statewide repositories of health insurance claims from all payers can provide invaluable price and quality information. Private Action
  • National health plans are developing transparency tools including cost calculators or estimators to allow members a better understanding of price information for various services.
  • Health care transparency is a hot area within digital health and venture capitalists have invested $400 million into health care transparency startups since 2010, according to CB Insights. Among the later-stage startups benefiting from this investment are Castlight Health and GoHealth. But analysts say that startups are focusing on all facets of cost transparency including those aimed at patients, employers, providers, and even insurance companies.
 

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