Open the curtain

Thank you for the timely reprint of an editorial from the New York Daily News regarding the Pricing Transparency Act mandated by the Centers for Medicare and Medicaid Services. The intention of this mandate was to compel hospitals to provide useful price information to patients so that they can make informed decisions about their care.

As a joint replacement surgeon, this topic is of particular interest to me and my colleagues at the University of Arkansas for Medical Sciences (UAMS). We recently completed a study of the top 50 orthopedic surgery facilities in the United States (according to US News and World Report rankings) to see how many were in compliance with the price transparency mandate to provide information on the costs of orthopedic surgeries. hip and knee replacement.

Unlike the recent report which found poor overall hospital compliance (14%), we found that 88% of these top hospitals were in compliance with the mandate. However, we were concerned about how this cost information is provided to patients. We found that the vast majority of hospitals only provided cost information for joint replacements using obscure billing codes, with very few hospitals offering the ability to find price information with a keyword search , like “total knee replacement”.

We also found it difficult to find this price information on many hospitals’ websites. Although the information provided is in line with this new mandate, it is not usable by patients if they are even able to find it. Hospitals must do better.

This is a complicated problem with no quick and easy solution. The process of receiving care is unfortunately not a simple transaction like buying a soft drink where the price listed is the price you will pay. Many entities are affected by healthcare costs, including providers, medical device and pharmaceutical companies, hospitals, insurance companies, and the patient.

As a health care provider, we always seek to put the best interests of the patient first when providing medical care. Unfortunately, in the American healthcare system, patients often don’t come first, as the business of medicine becomes more about outcomes. Until recently, hospitals and insurance companies were able to keep price information, which is often quite complicated, confidential.

For example, a hospital typically charges the insurance company a much higher amount than it expects to be paid for the service provided. The insurance company can then pass on part of the bill to the patient or refuse to pay part or all of the bill. Have you ever tried to buy a soft drink for $3 and told the cashier that you would only pay him $1 and if he didn’t accept the reduced price, you wouldn’t pay it at all? This is a simplified example of what happens in the background when a patient receives care. The patient, who is left in the dark for most of the process, often ends up with a complicated and confusing bill.

Insurance companies, the pharmaceutical industry and hospitals have sued the federal government over this recent price transparency mandate, saying it hurts competition in the marketplace. My colleagues and I would say the opposite. For too long, major players have been allowed to avoid competition in an open market, and financial decisions that directly affect patient care are made and kept behind closed doors.

We need to shine a light on health care financing and allow the public to see behind the curtain. The process should be simplified when the price quoted is the price paid and the information is provided in a format that is easy for the public to understand. Despite its good intentions, I fear that the Price Transparency Act is falling short of its goal of providing patients with useful and actionable price information. However, it is an important first step towards providing relevant cost information to enable patients to shop for care.

Ben Stronach, MD, is an orthopedic surgeon at the University of Arkansas for Medical Sciences.