House Passes Bill Targeting Healthcare Price Transparency
The bipartisan Lower Costs, More Transparency Act (H.R. 5378) was passed by the U.S. House of Representatives, primarily seeking to provide patients with accurate information regarding the cost of procedures and services. Specifically, the bill requires healthcare price information from hospitals, insurance companies, labs, imaging providers, and ambulatory surgical centers, which would be obligated to publicly list the prices they charge patients in machine-readable files. It would also require health insurers and pharmacy benefit managers (PBMs) to disclose negotiated drug rebates and discounts.
In addition, the bill would delay payment cuts for hospitals that treat high volumes of uninsured patients, which were expected in 2024 are now delayed until 2026; and provide “site-neutral” drug payments for Medicare regardless of whether they are given in an hospital outpatient departments (HOPDs) or doctor’s offices.
Currently, HOPDs receive higher drug payments for Medicare than independent physician offices or ambulatory surgery centers. Hospitals argue that the site-neutral policy would cut their revenue by more than $3.7 billion over the next ten years (according to the Congressional Budget Office).
The bill has faced and is continuing to face opposition from the healthcare industry and some lawmakers. The American Hospital Association (AHA) and the Federation of American Hospitals sent individual letters to Congress expressing concerns regarding the new regulations. “Government underpayment is a long-standing issue that needs to be addressed, not exacerbated,” the AHA wrote in a letter sent to Congress last week. “This proposal would expand upon these shortfalls, further exacerbating the financial challenges facing many hospitals and threatening patients’ access to quality care.” Despite these efforts, the House passed the bill with a 320-71 vote. The bill now heads to the Senate. Earlier this year, CMS updated their process to enforce compliance with the hospital price transparency update requirements to include giving specific deadlines in which hospitals should be in full compliance, automatically imposing civil monetary penalties and streamlining the compliance process, ultimately shortening the time that hospitals must come into compliance. The Fifth Semi-Annual survey performed and published by PatientRightsAdvocate.org (PRA) found that 36% of hospitals were fully in compliance with the transparency rule.
