Jul 29, 2019

Hospitals must post prices in new Trump administration proposal

A patient likely has no idea how much this blood draw costs. Photo: Glenn Koenig/Los Angeles Times via Getty Images

Starting in 2020, hospitals have to start publicly publishing the negotiated prices of procedures and tests they receive from health insurers, according to a proposed regulation from the Centers for Medicare & Medicaid Services.

Why it matters: Seeing the secretly negotiated amounts that private insurers actually pay for hospital care would shed light on the true cost of care. But some experts worry patients wouldn't know what to do with that information, and the disclosure could lead to lower-priced hospitals raising their rates.

Between the lines: CMS already requires hospitals to publish the list prices of their services, which don't reflect insurance discounts but do apply to people who are uninsured or receive care that is out-of-network.

  • But this proposal would go a lot further, by requiring all hospitals to show how much they get paid for at least 300 "shoppable" services, like imaging scans and scheduled surgeries, from every commercial insurer that has a contract with them.
  • The data has to be in a machine-readable format as well, which would help health care researchers.

Yes, but: Hospitals that don't comply with this requirement would face a maximum penalty of $300 per day, or about $110,000 per year.

  • That's a drop in the bucket for the largest hospital systems, raising questions about whether dominant organizations would follow the regulation.
  • But the fines would be tougher to swallow for smaller, rural facilities.

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Hospitals are safe on the debate stage, but not in Washington

Illustration: Lazaro Gamio/Axios

Hospitals are the largest contributor to rising health care costs in the U.S., yet have gone unmentioned in the Democratic presidential debates so far — a reflection of their relative political popularity over drug companies and insurers.

Yes, but: Hospitals are fighting multiple battles in Washington, where lawmakers and the White House seem increasingly emboldened to take them on.

Go deeperArrowAug 2, 2019

Hospitals winning big state battles

Illustration: Aïda Amer/Axios

Several states have made ambitious attempts to address health care costs, only to be thwarted by the hospital industry.

Why it matters: States' failures provide a warning to Washington: Even policies with bipartisan support — like ending surprise medical bills — could die at the hand of the all-powerful hospital lobby.

Go deeperArrowAug 15, 2019

The plight of America's rural health care

Illustration: Sarah Grillo/Axios

Rural America is stuck in a cycle of increasingly vulnerable patients with declining access to health care.

Why it matters: Rural patients often can't afford care, are being hounded by hospitals and collection agencies over their unpaid bills, and are facing the reality of life in communities where the last hospital has closed.

Go deeperArrowAug 21, 2019 - Health