Hospital Price Transparency Bill Advances in the Senate

 A bill to make healthcare facilities' prices more transparent passed the Senate health committee Wednesday by a vote of 21-1, clearing the way for a vote by the full Senate.

One hundred million Americans have a combined $220 billion in medical debt, according to Sen. John Hickenlooper (D-Colo.), a cosponsor of the bill.

"People go into a hospital, get what they think is a simple procedure, and they come out impoverished," he said at a Wednesday press conference. "These are people whose lives are being twisted and diminished because they've got the anxiety and the reality of insufficient healthcare."

Where all that money goes is unclear, said Hickenlooper. "It's a completely blind system. Our bill lets patients know before they go in the hospital what it's going to cost," he added.

Hickenlooper was referring to the Patients Deserve Price Tags Act, which would require public reporting of negotiated rates, costs, and cash prices for services provided at hospitals, ambulatory surgery centers, imaging centers, and clinical labs.

"Put simply, we require the actual price to be shown, not just kind of how you get there," said Sen. Bill Cassidy, MD (R-La.), a cosponsor of the bill. "That's powerful for the patient."

The bill also ensures group health plans have access to claims data and prevents third-party administrators from restricting data access, according to a press release issued by Hickenlooper and Sen. Roger Marshall, MD (R-Kan.), the bill's chief sponsor. "Providers or facilities will also be required to include a detailed itemized bill of each distinct item or service, or an all-in total price for bundled items if offered to the patient as an option," according to the release.

And unlike previous executive orders on this topic issued by President Trump and President Biden, this one has teeth, said Hickenlooper. "There will be civil penalties for non-compliance. Hospitals won't be able to go out and collect debts if they are out of compliance," he said.

In addition, hospitals that are willfully noncompliant with the transparency law at least twice during a 1-year period will face penalties ranging from $500,000 to $10 million depending on their size.

The bill could make a difference on Americans' cost of living, saving families as much as $1,000 per month, according to Marshall. "Our bill forces transparency. It forces competition," he said.

"It's critical not to make this too abstract," said Cassidy, chair of the Senate health committee.

For example, a Louisiana family taking their child for an x-ray may not realize there's a facility fee associated with the x-ray.

"There's $500 on that healthcare bill that they didn't know was going to be there, and the family doesn't know how to pay for it," Cassidy said. "That's what this is about. Let's bring relief to that family who, at the end of the month, doesn't have the money to pay their bills."

Over in the House, a similar bill known as the Lower Costs, More Transparency Act passed out of the Energy & Commerce Health Subcommittee last month and was referred on to the full Energy & Commerce Committee. However, Marshall called that bill a "base" bill, adding, "It's something that we included in our bill, and then we closed all the loopholes." Hickenlooper agreed, saying the Senate bill was "a little more rigorous."

"Our version is more fundamental, period," said Cassidy. "It gives employers full access to their data while maintaining strong patient protection." For instance, if a patient whose employer is self-insured goes to an out-of-network provider and the insurer pays the provider $20,000 but bills the employer $60,000, "that's exposed. The employer now knows exactly what the insurance paid for that out-of-network doctor."

https://www.medpagetoday.com/practicemanagement/reimbursement/122314