By Drs. Mark Lopatin and Arvind Cavale
Imagine walking into a restaurant and seeing every menu item listed as “Market Price”. You ask what that price is, but the waiter can’t tell you. Now imagine that all the restaurants in town have all of their items listed as “Market Price”. How would you decide what to order and where?
This is exactly the situation Americans find themselves in when they need hospital care.
The same test or procedure at two different facilities can have drastically different negotiated prices, often thousands of dollars apart, and the patient has no way of knowing. This difference is significant for the large number of patients who have high deductible plans who end up bearing most of the costs. What we need in healthcare is the equivalent of a Kelley Blue Book for cars, a resource for average patients to know how much care should cost. This lack of price transparency is not happening in any other industry, and it must end in health care.
Americans should know the cost of their health care before they get it.
The federal government addressed this problem by releasing the rule of transparency of hospital prices, which entered into force on January 1. The problem is that many hospitals don’t comply. A report released last month by a national nonprofit showed that the vast majority (94.4%) of hospitals, including most of those in Pennsylvania, were not following the rule. The refreshing exception was Temple University Hospital, which the report said was among the less than 6% of US hospitals with all their prices. This hospital deserves to be congratulated.
While doctors are often blamed for rising healthcare costs, we can assure you that doctors want what patients want. We also want to know the prices, but hospitals and insurers are also keeping us in the dark.
We wrote to Pennsylvania Attorney General Josh Shapiro asking him to help enforce the law and hold hospitals to account. To do this, our government must significantly increase the financial penalties imposed on hospitals that do not comply with the rule. Currently, the penalty is only $ 300 per day. It is woefully insufficient. Worse, the government has no fine to a single hospital yet for breaking the government’s own rule. What is the use of a toothless law? The fine must be considerably increased and rigorously enforced. We should also eliminate the loophole in the rule that allows hospitals to simply provide estimates, not guaranteed prices.
As physicians, we care about the physical and financial health of our patients. We don’t want to see them neglecting their care because they can’t know the cost. The best way to protect their finances is to have full price transparency. The ability to view and compare prices online would pave the way for price competition, lowering prices, allowing patients to buy the best value for their healthcare dollar, and slowing down the cost. unhealthy trend towards consolidation in the healthcare sector. We hope our attorney general agrees.
We have a long way to go to address the dysfunctional funding of our broken health care system. Transparency is an essential part of the solution. The right to know the cost of care before receiving a surprise bill is essential. Consumers should demand nothing less.
Dr. Mark Lopatin is a rheumatologist in Willow Grove, Pennsylvania. Dr. Arvind Cavale is an endocrinologist in Feasterville, Pennsylvania. Both are members of the Association of Independent Physicians.