But insurers are complying under the Transparency in Coverage regulations and that is where discrepancies in the disclosure of prices to the public have been found
Despite federal regulations requiring hospitals to publicly post their prices in advance of patient services, some large health systems still do not follow the law. That’s according to a new Transparency in Coverage Report from PatientRightsAdvocate.org (PRA), which found that some hospitals are “flouting” the federal Hospital Price Transparency Rule.
By cross-referencing price disclosures by hospitals and insurance companies, which are required to publish the amounts they pay for hospital services under federal Transparency in Coverage regulations, PRA, a 501(c)(3) nonprofit, nonpartisan organization, discovered the healthcare providers’ noncompliance with federal transparency regulation.
“Prices revealed in newly released health insurance company data files show some major American hospitals are omitting prices from their required price disclosures in violation of the federal hospital price transparency rule,” according to the PRA report.
Hospitals conceal their prices because they don’t want people to know how much rates for the same procedure vary,” Sally C. Pipes (above), President and CEO of Pacific Research Institute, wrote in the Washington Examiner. “A lack of price transparency benefits hospitals but not patients or payers. The federal government should not let providers get away with flouting the law,” she added. Clinical laboratories are also required under federal law to publish their prices. (Photo copyright: The Heartland Institute.)
“PatientRightsAdvocate.org discovered several instances in which prices were omitted from the hospital files but appeared in the insurance company files,” noted the PRA report. “These discrepancies indicate that some large hospitals are not posting their complete price lists as required by the hospital price transparency rule.”
The federal Centers for Medicare and Medicaid Services (CMS) says hospitals must post standard charges in a single machine-readable digital file, and display in a consumer-friendly way, “300 shoppable services with discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges.”
But according to the PRA report and news release, the study team discovered that this was not always the case. Below are examples from the report of some of the discrepancies between prices on a hospital’s website and what payers’ websites showed as prices involving those same hospitals:
PRA’s report casts light on inconsistencies between what insurers and providers share with the public on prices.
“Today’s report confirms that hospitals are hiding prices from patients and [this] calls into question their public assertions that individual prices don’t exist for many of the services they provide,” said PRA Founder and Chairman Cynthia Fisher in the news release.
“The data made possible by the [federal] Transparency in Coverage (TiC) rule reveals prices negotiated with insurers that hospitals did not disclose in the machine-readable files required by law. Our report is just the tip of the iceberg of what the staggering amount of data in TiC disclosures will reveal,” she added.
Ascension, HCA Note Compliance with CMS Rule
For its part, Ascension, in a statement to Healthcare Dive, confirmed it is complying with the CMS rule and offers consumers tools to estimate costs.
“We’re proud to be a leader in price transparency,” Ascension said.
HCA told Healthcare Dive it has “implemented federal transparency requirements in January 2021 and provides a patient payment estimator in addition to posting third-party contracted rates.”
Advice for Clinical Laboratories Sharing Test Prices
Hospitals flouting the federal transparency rule is not new. Dark Daily has covered other similar incidences.
Clinical laboratory leaders who oversee multiple labs in healthcare systems may benefit from advice about CMS rule compliance shared in HealthLeaders.
Post a separate file for each provider.
Be “cognizant” of different sets of standard charges for multiple hospitals under one license.
“Today’s healthcare consumer wants to know prices in advance of service. That’s because many have high deductible health insurance plans of, say, $5,000 for an individual or $10,000 for a family as the annual deductible,” said Robert Michel, Editor-in-Chief of Dark Daily and its sister publication The Dark Report.
Clinical laboratory tests may not be the most expensive healthcare service. But they are critical for high-quality hospital care and outcomes. Increasingly, patients want to know in advance how much they will cost. This is true of patients of all generations, from Baby Boomers to Generations X, Y, and Z.
Hospital laboratories may find GPOs respond by contracting with more vendors to expand choices of products
Major changes are unfolding in the world of group purchasing organizations (GPOs). As healthcare’s transformation shifts the clinical and financial emphasis of hospitals, health systems, and other providers, these institutions are changing their relationship with GPOs.
In turn, such trends mean changes in the GPO contracts available to hospital laboratories. In the United States, every hospital and health system is typically a member of at least two GPOs. Thus, the clinical laboratories of these hospitals must also participate in the national contracting programs operated by the GPOs. (more…)
These annual rankings show that the nation’s largest healthcare systems continue to grow in revenue and bed count
When it comes to the nation’s largest healthcare systems, it is no surprise that the U.S. Department of Veterans Affairs (VA) tops the list, at least when ranked by annual revenue. That is the finding of a “Top 10” survey of healthcare systems recently published by Modern Healthcare magazine.
This survey is useful to pathologists and clinical laboratory managers because these “Top 10” healthcare system rankings also provide insight as to where the nation’s largest hospital-based laboratory organizations can be found. For example, the VA operates 164 acute-care hospitals. That represents a large volume of clinical laboratory testing for those inpatients.
If there is one healthcare trend that will be truly disruptive to pathologists, it is personalized medicine. The concept behind personalized medicine is simple: understand the genetic and metabolic differences unique to the individual patient. Then use this knowledge to tailor a custom program of therapy, including prescription drugs, that offers the maximum potential for success while minimizing possible side affects.
Personalized medicine is closely linked to the emerging field of companion diagnostics. In combination, these two new ideas have the potential to revolutionize how laboratory testing services are used in developed healthcare systems. For one thing, clinical laboratories and anatomic pathology groups-traditionally the “go to” source for information to drive diagnostic, prognostic, and therapeutic decisions-will have serious competitors in the world of personalized medicine and companion diagnostics.
One keen observer of the personalized medicine trend is Bruce Friedman, M.D., Professor Emeritus of Pathology at the University of Michigan Medical Center in Ann Arbor, Michigan. In his popular LabSoft news blog, he defined companion diagnostics in this manner:
Briefly stated, [companion diagnostics] is a strategy pursued by some IVD companies, Roche Diagnostics in particular, whereby the company develops a gatekeeper biomarker assay. This is a lab test that serves to qualify a patient for treatment with a particular drug. The most common example of such a test is the HER-2/neu assay that is required prior to treatment with Herceptin.
Friedman, like your Dark Daily editor, recognizes that advances in genetic science and molecular technologies are making it possible for other medical specialties to crowd into the diagnostic field. He believes that the current, commonly-used definition of companion diagnostics-as primarily measurement by use of serum biomarkers-is outdated. He thinks the definition should be widened, writing in his blog that: “I personally have begun to routinely assume that diagnostics, unless otherwise qualified, should be more broadly defined to include both the analysis of serum and tissue biomarkers as well as medical imaging procedures. I have posted a number of notes about molecular imaging, which is defined in the following way in the Wikipedia:
[Molecular imaging] differs from traditional imaging in that probes known as biomarkers are used to help image various targets or pathways, particularly. Biomarkers interact chemically with their surroundings and in turn alter the image according to the molecular changes occurring within the area of interest. This is markedly different from previous methods of imaging which primarily imaged differences in qualities such as densities or water content.”
Friedman continues, saying: “I think that we now need to broaden our definition of companion diagnostics to include both the measurement of serum/tissue biomarkers as well as medical imaging and particularly molecular imaging. Such an approach also echoes my belief, expressed in a number of previous notes, that pathology, lab medicine, and radiology are becoming much more closely aligned and should now merge into a new discipline of diagnostic medicine. This broader definition for companion diagnostics also suggests that Roche, GE, and Siemens are embarking on very similar strategy in the pursuit of personalized medicine.”
All pathologists and radiologists should track this trend, which is poised to disrupt long-standing practices in their respective medical specialties. Friedman will speak on this topic at the upcoming Molecular Summit on the Integration of In Vivo and In Vitro Diagnostics in Philadelphia on February 10-11, 2009. Location is the Sheraton Society Hill Hotel in Philadelphia, Pennsylvania. Joining Friedman is a faculty of 27 other leading national and international experts in molecular imaging, molecular diagnostics, and healthcare informatics.
Speakers from such organizations as Massachusetts General Hospital, Stanford University Medical Center, MD Anderson Medical Center, UCLA Medical Center, Siemens, and the Institute for Systems Biology will provide the latest innovations in the integration of in vivo and in vitro diagnostics. Last year’s Molecular Summit attracted 225 attendees, along with editors and reporters from 15 healthcare publications. This upcoming Molecular Summit has compelling case studies of how molecular diagnostics, when integrated with molecular imaging and other data sets, is giving clinicians powerful new insights for making diagnoses, identifying appropriate therapies, and monitoring patient progress.
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Watch out! Coming soon may be tests done on low-cost, paper-based “lab-on-a-chips.” Researchers at Harvard University are working to put assays on paper to improve diagnostics in developing countries. The paper-based test strips are similar to those used in at-home pregnancy tests, but may soon be able to offer inexpensive tests for liver, kidney, and metabolic diseases. The researchers aim to develop tests that are easy-to-use, cheap, portable, and disposable.
Although the goal is to make this testing and mass screening device affordable in developing countries, the technology easily could work its way into developed healthcare systems if it delivers high levels of sensitivity, specificity, and reliability.
The university’s Whitesides Research Group is working with Diagnostics-For-All (DFA), a non-profit venture in Cambridge, Massachusetts, to develop the low-cost, paper-based “lab-on-a-chip,” as DFA calls it. These simple diagnostic tests could be used in resource-poor areas of the globe. The technology was developed in the laboratory of George M. Whitesides, Ph.D., the Woodford L. and Ann A. Flowers University Professor, Department of Chemistry and Chemical Biology at Harvard University and a co-founder of DFA.
Here’s how it works. A paper-based microfluidic chip the size of a fingernail is pre-treated with reagents for color-based (or colorimetric) assays to test bodily fluids (such as blood, urine, or sweat) for proteins and other molecules that indicate the presence of disease. The paper is patterned with hydrophobic polymers, forming a series of channels that guide a fluid sample to pre-treated regions of the chip. The resulting color changes can then be read and translated into a diagnosis using a key based on the test being conducted.
The technology offers four distinct advantages over current diagnostic systems. First, the use of paper means the chips could be significantly cheaper-potentially as low as 1 cent per chip-than other microfluidic designs, which use on silicon, plastic, or glass.
Second, the technology is highly portable. No specialized equipment is required to process and read samples, and because it uses the inherent capillary action of paper, the device does not require pumps or power sources.
Third, the device is user-friendly allowing healthcare providers to read the color-based results in minutes with minimal training. DFA could train individual providers to conduct the tests using the chips, and then use cell phones to call doctors who would advise on diagnosis and treatment.
And, fourth, it can be disposed of easily and safety through incineration, which is significant in the developing countries that may lack the resources for biological waste disposal.
“What we have with this technology is the means to help address significant diagnostic disparities between the United States and the developing world,” Whitesides said. “For instance, over time about 5% of patients in the developing world receiving treatment for tuberculosis or AIDS-equivalent to approximately 1 million people-will succumb to drug-related liver complications because of a lack of proper health monitoring. In the United States, tests for these complications are conducted every two weeks, with results returned within hours. In the developing world, when these tests are done, which is rarely, it can take laboratories weeks to send back the findings.
“By developing a low-cost and broadly applicable test system designed to be deployed in regions with no or little access to complex laboratory diagnostic equipment, we hope to make a real impact on public health,” Whitesides added.
