Many hospitals are staffed by doctors who are not directly employed, or rely on laboratories that are also separate. It also is still unclear how the administration would enforce the rules.Īnother limitation to the executive order: It applies only to hospitals and the medical staff they employ. In theory, at least, the information that would result from Trump's executive order would provide more detail based on negotiated, discounted rates.Ī senior administration official at the press briefing said details about whether the rates would be aggregated or relate to individual hospitals would be spelled out only when the administration puts forward proposed rules to implement the order later this year. Also, those list charges don't reflect the discounted rates insurers have negotiated, so they are of little use to insured patients who might want to compare prices from hospital to hospital. What's resulted are often confusing spreadsheets that contain thousands of a la carte charges - ranging from the price of medicines and sutures to room costs, among other things - that patients have to piece together (if they can) to estimate their total bill. In January, new rules took effect under the Affordable Care Act that require hospitals to post online their "list prices." These are prices hospitals set and have little relation to actual costs or what insurers actually pay. Q: Isn't this information already available? In theory, that would allow consumers to shop around for lower-cost care. Also, many medical services are needed without much notice - think of a heart attack or a broken leg - so shopping for price simply isn't possible.Īdministration officials say they want patients to have access to more information, including "advance EOBs" that outline anticipated costs before patients get nonemergency medical care. But research shows few patients use such tools. Some insurers and hospitals do provide online tools or apps that already can help individual patients estimate out-of-pocket costs for a service or procedure ahead of time. "People are sick and tired of hospitals playing these games with prices," says George Nation, a business professor at Lehigh University who studies hospital contract law.
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Uninsured patients often are charged the full amounts. In addition to consumers being unable to get price information upfront in many cases, hospital list prices and negotiated discount rates vary widely by hospital and insurer, even within the same region. That's when insured patients get an "explanation of benefits," which shows how much the hospital charged, how much of a discount their insurer received and the amount a patient may owe.
The order directs agencies to develop rules to require hospitals and insurers to provide information "based on negotiated rates" to the public.Ĭurrently, such rates are hard to get, even for patients, until after medical care is provided. It may expand price information consumers receive. Trump's executive order already is running into opposition from some hospitals and insurers who say disclosing negotiated rates could drive up costs.Īs health care consumers await more details on those rules, here's what we know: Other health care analysts say much depends on how the administration writes the rules over the next several months - rules that govern what information must be provided and in what format. If the executive order leads to finalized HHS rules, proponents say it could encourage competition and lower prices.
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"This will put American patients in control and address fundamental drivers of health care costs in a way no president has done before," Health and Human Services Secretary Alex Azar said during a press briefing Monday.īut just how useful the effort will prove for consumers remains unclear. Also, hospitals and insurers would have to give estimates on out-of-pocket costs to patients before they go in for nonemergency medical care. The order directs agencies to draw up rules requiring hospitals and insurers to make public more information on the prices they hammer out in contract negotiations. President Trump signed an executive order Monday that he says would make such comparisons easier, and make the pricing process more transparent. Anyone who has tried to shop around for hospital services knows this: It's hard to get prices in advance.
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