If the Power To The Patients campaign is successful, thousands of people will leave Cape Cod beaches this summer knowing they now have a right to know the cost of medical care before receiving treatment in a hospital.
In early July, pilots began towing banners designed by artist and activist Shepard Fairey in the sky over Cape Cod by plane. The banners will fly over Cape Town beaches every Saturday and Sunday for the next eight weeks.
The banners feature a patriotic color scheme and a clenched fist holding a winged staff entwined with snakes, the symbol of medicine, and carry the words “PRIX NOW A PATIENT’S RIGHT.” ASK THEM ”and the group’s website,“ POWERTOTHEPATIENTS.ORG ”.
The banners refer to a rule first enacted by the Centers for Medicare and Medicaid Services in November 2019 under the Trump administration, which requires hospitals to display payer-specific negotiated fees and minimum and maximum prices negotiated by the payer.
After an appeals court dismissed a challenge from the American Hospital Association and others, the rule went into effect on January 1, 2021.
The goal of the rule is to allow patients to plan their medical expenses and, in theory, to compare prices between hospitals to find the best value for money, thereby increasing competition and lowering prices.
Although more than 90% of Americans support price transparency in health care, according to a 2020 survey by LUGPA, a nonprofit medical association, few know that price transparency is now required of hospitals, said Kevin Morra, one of the early organizers of the Patient Power Campaign.
“This rule is out, which is an incredible right for all Americans now,” Morra said. “This is the first time in the history of the United States that such a warrant has been executed. The problem is, nobody knows it exists and hospitals don’t comply. They still don’t publish the prices.
Why don’t so many hospitals publish the prices?
A March study published in the journal Health Affairs found that 65 of the country’s 100 largest hospitals were “unambiguously non-compliant” with the new price transparency rule.
Wendy Netter Epstein is Professor of Law and Associate Dean of Research at DePaul University College of Law in Chicago, specializing in health care law and policy.
She said some hospitals have complained that the rule is poorly drafted, making compliance difficult, and others have complained that the complexity of the rule makes compliance with costs prohibitive during a pandemic that has put severe strain on compliance. tests hospital resources.
“One explanation that is less charitable for hospitals is that they called the administration’s bluff on whether the rule would really be enforced,” she said.
The first reprimand for non-compliant hospitals comes in the form of a warning that gives hospitals 90 days to correct the deficiencies, Epstein said, but then it is possible to send a second warning letter or plan to corrective action.
“Eventually, after many processes, they could owe up to $ 300 a day in financial penalties,” she said. “This is obviously not as severe a financial penalty as it could be.”
Perhaps more important than financial penalties is a provision in the rule that states that non-compliant hospitals will be listed on the Centers for Medicare and Medicaid Services (CMS) website.
“There is kind of a shameful aspect to penalties,” Epstein said. “The rule says that facilities that receive a civil monetary penalty will be publicly named on the CMS website. They are not there yet. No one has been listed at this point, but it is certainly a stick that the rule contemplates. “
But Epstein said CMS would likely give hospitals leeway to implement the rule’s requirements.
“I think hospitals know this, and that might partly explain why hospitals haven’t been incredibly quick to comply with the rule,” she said.
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In response to a Times request for information on steps Cape Cod Healthcare is taking to comply with price transparency rules, spokeswoman Patricia Pronovost wrote in an email that the system, which owns Cape Hospitals Cod and Falmouth, had price transparency tools on their websites since January 1 and understand price information from last year.
It is still unclear whether these resources bring Cape Cod Healthcare into compliance.
Ilaria Santangelo, research director at Patient Rights Advocate, a non-profit, non-partisan organization focused on transparency in healthcare pricing, told The Times in an email that “a price estimation tool compliant alone does not make the hospital compliant ”.
“Their machine-readable price list should include the five standard fees and codes relevant to making the hospital compliant, in addition to a compliant pricing tool,” she wrote.
Knowing that a hospital must now provide pricing information specific to each individual, patients interested in knowing the cost of the care they are seeking should ask these questions directly to their hospitals, Epstein said.
“Whatever care you expect from the hospital, you should be able to get a price that matches your insurer’s specific price, and if you can’t get it, that’s a good indication that ‘hospital is not in compliance with the rule,’ Epstein said.
“I think if you are a patient who cannot get this information from the hospital, you should go to the hospital administration and say that you are entitled to it,” she added.
Knowledge of the rule of transparency of medical costs is essential
In addition to helping people make informed financial decisions about their care, increased awareness of the hospital price transparency rule will allow people to collectively demand that their local hospitals comply, Morra said.
“Knowledge is power,” he said. “These prices should not be hidden. In droves when we call the hospitals and ask these prices and talk to our neighbors and our friends and our politicians who are in Washington, DC, and at the state level fighting for us, that’s what then those hospitals will be forced to comply. “
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That’s why, in addition to flying banners announcing new American patient rights on Cape Cod, the Power To The Patients campaign will fly planes towing the banner over other densely populated summer destinations, including the Hamptons. in New York and Santa Monica in California.
“It is important that all Americans hear this and we want our message to be where people live their lives, and certainly in the summer there is a high density of people around the beautiful beaches of Cape Cod so we want to be. there too, ”Morra mentioned.
Fairey’s works will also be painted as frescoes in cities across the country, including Detroit, Dallas, Indianapolis, Nashville and Albuquerque, Morra said.
Fairey, perhaps most famous for Barack Obama’s HOPE poster he designed, has a particular connection to the issue of cost transparency in health care. Fairey is type 1 diabetic and his wife suffers from multiple sclerosis.
“I have seen the devastation that the high cost of medical bills can create in people’s lives,” Fairey said in a public service announcement for the Power To The Patients campaign.
How important is the rule of transparency of medical prices?
Epstein said the transparent pricing rule for hospitals “could become a big problem over time.”
“I don’t think it will instantly be a big deal for a number of reasons,” she said. “There are two different objectives when it comes to price transparency. One is to influence patient behavior and the other is to influence markets. I think it’s going to take some time to figure out how effectively he can accomplish either of these tasks.
One of the concerns of Epstein and other health policy experts is that the rule will unwittingly cause low-income Americans to delay needed care. Another is that, because hospitals and insurers can now see the rates negotiated by competitors, the prices could go up instead of down.
Epstein said collecting and tracking data will be crucial to ensure these unintended outcomes are avoided.
She also noted that millions of Americans are still uninsured, and even with insurance, many cannot afford the cost of necessary health care.
“Price transparency rules won’t be able to help uninsured Americans pay for care, and out-of-pocket expenses, depending on how your insurance looks, can still be high,” she said. “The real goal of policy should be to make sure everyone can afford to get the care they need.”
New health care rules implemented under the Biden administration’s American Rescue Plan Act have opened the door to low-cost, if not no-cost, insurance for millions of Americans, Epstein said . Many unemployed and low-income Americans are now eligible for coverage.
“This is another thing that health policies are really trying to get the word out about,” she said. “The new grants are very generous and two million more people have already signed up to new policies this year, but there are so many more who are eligible who have not yet. “
To find out if you are eligible for coverage, visit health.gov.
Jeannette Hinkle can be contacted at capecodonline.com.