Latest news with #HospitalPriceTransparency
Yahoo
6 days ago
- Business
- Yahoo
PatientRightsAdvocate.Org Applauds Florida Attorney General's Bold Action to Protect Healthcare Consumers
TALLAHASSEE, Fla., May 30, 2025 /PRNewswire/ -- Today, (PRA) applauded Florida Attorney General James Uthmeier for formally opening an investigation into the deceptive and predatory practices of Florida hospitals flouting state law and federal price transparency rules. "Hospitals have hidden their prices yet have forced patients to sign a blank check before they can get care. As long as prices have been hidden, hospitals have been able to charge whatever they want," said Cynthia A. Fisher, Founder and Chair of PRA. Florida law states that unfair and deceptive acts and practices are "unlawful," which include omitting material information like prices. Yet, hospitals often require patients to sign contracts accepting full financial responsibility without any knowledge of prices. "The Attorney General's action seeks to protect patients through actual upfront prices. This investigation will protect Floridians from hospitals' predatory practices, prevent overcharges, and make bills accountable," continued Fisher. "Ultimately, these consumer protections will help Americans to lower their costs." The Attorney General's investigation is in line with President Trump's historic price transparency executive order that requires real, upfront prices, not estimates, which will empower consumers with competition and choice, and lower the cost of healthcare. Background: Across Florida, some hospitals have charge-to-cost ratios showing charges over 10x the hospital's cost. In 2021, non-profit Advent Health Orlando made news for billing a patient with insurance over half a million dollars following her son's birth. After a press inquiry, the hospital lowered the bill to just $300 total. In PRA's latest Hospital Price Transparency report, only 29% of Florida hospitals reviewed were in full compliance with the federal price transparency rule, and only 3% posted sufficient pricing data for consumers to shop and compare. Wide price variation is prevalent nationwide. Last week, CMS took steps to reveal all actual prices to consumers so they can identify the vast variation and make informed decisions. Price transparency has received wide bipartisan support in Congress and from Americans nationwide. According to a new poll by PRA, 96% of voters agree that Americans "deserve to know the price of their healthcare before they receive it." Economists agree that healthcare price transparency would save up to $1 trillion in the American economy annually. About PRA: (PRA) is a leading national healthcare price transparency organization dedicated to ushering in systemwide transparency through advocacy, testimony, media, legal research, and grassroots campaigns. PRA believes that the availability and visibility of actual, upfront healthcare prices will greatly lower costs for patients and employers through a functional, competitive healthcare marketplace. View original content to download multimedia: SOURCE Patient Rights Advocate
Yahoo
12-03-2025
- Health
- Yahoo
Hospitals keep dodging price transparency rules, leading Trump to take action — again
For 17 years, Michelle Arroyo did everything she could to keep her son alive after he'd been diagnosed with brain cancer at 6 years old. The single mom from California moved from Orange County to Los Angeles to be closer to the best doctors and medical facilities, quit her job in real estate to care for her son around-the-clock and liquidated all her financial assets, including her retirement account. But despite her best efforts, Arroyo's son, Grayson Arroyo-Smiley, died in 2023 at 22 years old, leaving Arroyo distraught and saddled with mounting medical bills that soared, she said, into the millions. She was also left with a feeling that she'd been swindled by health care companies into having to pay both physically and emotionally for wanting the best for her son. 'The process is just so overwhelming,' Arroyo said, describing her experience in dealing with the growing number of bills and phone calls with insurance companies. 'It was like going through this in the dark,' she said. 'You never knew what you were going to get. When you are trying to save a loved one's life, you are not going to ask prices.' Had she known about those prices up front, Arroyo said, she would have been better able to make more informed decisions about care. For several years, the federal government has been pushing for more price transparency from hospitals. In 2019, during his first term, President Donald Trump signed an executive order aimed at improving price transparency by requiring hospitals and insurers to disclose health care costs upfront. As a result, the Hospital Price Transparency rule went into effect in 2021. The rule made it mandatory for hospitals to post standard charges for their services on their websites. Compliance, however, has been lacking: One study published in 2022 in the Journal of the American Medical Association found that fewer than 6% of hospitals were fully compliant with the rule. A 2024 report from the inspector general of the Department of Health and Human Services found that just under two-thirds of hospitals sampled complied. This came despite President Joe Biden signing his own executive order in 2021 to tighten enforcement by fining hospitals that did not comply. When that order went into effect the following year, some hospitals continued to ignore the rules outright, while others accepted the fines, which were capped at $5,500 a day. Trump is once again trying to increase compliance. In late February, he signed an executive order directing the Departments of Treasury, Labor, and HHS to develop a plan in the next three months to enforce the price transparency rule. Arroyo said that if this kind of information had been available to her, she would have been able to better financially manage her son's health care needs and ensure she was getting the value she desired. 'If the prices were posted for me,' she said, 'I would compare the prices I got versus what others got. The fact that others get different prices, it's not right.' Arroyo estimated that in the last 10 years of her son's life, she spent hundreds of thousands on one medical supply that cost about $500 a month and fell outside of her insurance's coverage. She recalled getting another medical bill for $1.5 million for less than 90 days of a five-month stay that her son spent in the ICU. The bills, she said, seemed to never end. Though insurance covered most of them, she says, she consistently had to negotiate the prices down. Today, she said, she is still paying off $14,000 of medical debt. Because of her professional experience in negotiating real estate contracts, she was able to haggle some services down, but she questions how others could manage a similar experience. 'If you don't have that information, how can you do it?' Advocates of Trump's order believe that more transparency in health care prices will lead to increased competition for hospitals and insurers, which, they say, will drive down costs for consumers. 'The bad news is for hospitals who charge rates that are higher than they should be in the markets they're in — this rule change will likely increase scrutiny, and hopefully competition, for them,' said James Gelfand, president and CEO of the ERISA Industry Committee, a national nonprofit organization that represents large employers that pay for their own health insurance. 'If it works the way the administration hopes it will, those outliers will reduce prices to be more competitive, potentially saving patients and employers tens of billions of dollars over the next decade,' Gelfand said. The order will benefit patients and employers with 'more, better data that can be used to get the best care at the best prices,' he added. There's already some evidence that's already happening. Ge Bai, a professor of accounting and health policy at Johns Hopkins University in Baltimore, noted that the costs from some hospitals have already dropped due to the 2019 price transparency rule, pointing to a recent analysis from Turquoise Health, a health care pricing platform. Other public health experts, however, are wary that one executive order alone can serve as a magic bullet to the challenges in health care cost transparency that have saddled the industry for decades. 'I don't think there is any downside, but I don't think there is any upside either,' said Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health, who contends that comparing prices in practice for consumers becomes both laborious and complex when it's based on averages and 'no one understands how it works.' Nearly 100 million Americans — or 1 in 4 adults — are hampered by more than $220 billion of medical debt that they cannot afford, according to the Consumer Financial Protection Bureau. If the Trump administration can effectively enforce the rule, the beneficiaries will be financially disadvantaged patients, regardless of race, who will gain the most from price competition, while higher-priced hospitals will be harmed the most, public health experts said. 'There is huge public support for this initiative,' Bai said. Some of that support comes from an unlikely source: the rapper Fat Joe. The Bronx-born hip-hop artist is an ambassador for the nonprofit Power to the Patients, an advocacy group that pushes for accessible health care. Through PSAs, public art installations and in-person events, the organization since 2021 has pushed for more price transparency. Fat Joe said he got involved after learning the scale of the issue and how the lack of transparency was financially crippling people all around him. He's appeared in commercials, spoke on Capitol Hill and advocated on social media about the need for price transparency virtually since the organization's inception. 'People are tired of these prices' that are often inflated, said Fat Joe, adding that when people go to hospitals for a service, 'it's like a game of lottery, which is really more like Russian roulette.' Melissa Deitrich, a 49-year-old single woman from Ossian, Indiana, believes she would benefit greatly from greater price transparency. Deitrich, who's gotten involved with Power to the Patients, said she was overcharged by her provider by more than a thousand dollars for a routine checkup and now drives more than two hours to the closest clinic that lists their prices upfront. 'It's worth the peace of mind,' she said. 'Complete price transparency is the only way patients will ever be able to trust their health care system.' Some public health experts, however, are hesitant to oversell the potential transformation the new order could bring. Hospital groups in 2020 opposed to the changes unsuccessfully challenged the previous Trump administration in court, arguing that the requirements would undermine their negotiations with insurers and violate their First Amendment rights. Denise Anthony, a professor of health management and policy at the University of Michigan, said that because of the complicated nature of health care pricing, she's unsure this order will have much of an impact. 'There is evidence that even when clear pricing data is available to patients, they don't use it to move to a different hospital/provider,' Anthony said in an email. 'There are all kinds of reasons people go to the same hospital despite lower prices somewhere else — physician, history, quality, convenience, etc.' Companies like Handl Health, a platform that uses artificial intelligence to compare health care costs, have firsthand experience in how price transparency can be effective and how it can falter. The company's CEO and founder, Ahmed Marmoush, sees promise in Trump's executive order, but believes the order alone doesn't go far enough. While pricing data is flooding the market, he says, some health providers 'have fallen short of full transparency — whether by publishing duplicate or misleading rates, omitting key data or making information difficult to access.' Anderson, of Johns Hopkins, believes the impetus behind the order is positive, but he's unsure it's anywhere close to materializing into something real. 'It's valuable,' Anderson said. 'It's just not ready for prime time — and I don't know how it can ever be ready for prime time.' This article was originally published on
Associated Press
29-01-2025
- Business
- Associated Press
PBGH Launches Groundbreaking Health Care Data Project, Tackling Data Transparency Challenges and Strengthening Employer Fiduciary Compliance
Oakland, California, Jan. 29, 2025 (GLOBE NEWSWIRE) -- Amid the untenable healthcare affordability crisis, Purchaser Business Group on Health (PBGH), a nonprofit coalition representing 40 private employers and public entities across the U.S., announced the launch of its commercial health care data project to equip employers with vital and unprecedented transparency on the cost and quality of commercial health care and key insights that will enable them to be effective, prudent fiduciaries. In this first deployment, PBGH will aggregate and analyze the actual claims and demographic data from five jumbo employers and public purchasers across ten geographic markets with Hospital Price Transparency rule datasets, Transparency in Coverage ('TiC') payer datasets and provider quality metrics to meet fiduciary requirements under the Consolidated Appropriations Act (CAA). The employers' data will be combined with the transparency files to generate comparative commercial benchmarks correlating cost and quality and provide employer-specific use cases based on their exact data – achieving unprecedented transparency and customized analytics to inform the employers' carrier and network strategy, direct contracting, and more. 'PBGH created this initiative because employers do not have access to the data they need to be prudent fiduciaries,' explained Won Andersen, Chief Operating Officer of PBGH. Under the project, PBGH will analyze cost variations, allowing employers to compare the best 'deal' by hospital, network, and carrier based on actual prices at the service code level, rather than relying on self-reported aggregated carrier data. Additionally, it will correlate price variation data with provider quality data to provide a comprehensive understanding of value. 'We are developing a new level of transparency and analysis that does not currently exist for the commercial market,' continued Andersen. 'This project represents a pivotal step toward enhancing transparency and accountability in health care spending and purchasing, ultimately benefiting employers and their employees and families.' 'The high cost of health insurance is a growing burden on employers and slows wage growth for workers,' said Caroline Pearson, executive director of the Peterson Center on Healthcare. 'Yet companies that are motivated to deliver higher-value coverage for their employees still lack the data, tools, and market influence to stem the rise in health care spending. This initiative will empower employers with critical insights into the cost and quality of care to foster informed decision-making.' The PBGH Health Care Data Project is supported by a grant from the Peterson Center on Healthcare. About Purchaser Business Group on Health PBGH is a nonprofit coalition representing nearly 40 private employers and public entities across the U.S. that collectively spend $350 billion annually purchasing healthcare services for more than 21 million Americans and their families. In partnership with its members, PBGH initiatives are designed to test innovative operational programs and scale successful approaches that lower healthcare costs and increase quality across the U.S.
