How the Lower Costs, More Transparency Act Helps Patients
It’s time to change the status quo and make health care more affordable
H.R. 5378, The Lower Costs, More Transparency Act, was written with patients in mind so they can find the right care at a price they can afford. It includes solutions like making hospitals post their prices—something that 95 percent of Americans support.
Don’t miss these stories on how this bill will make a real difference in people’s lives.
RIGHT NOW: Hospital pricing is complicated and hard to navigate. Dani Yuengling, a patient from South Carolina, had a $6,000 deductible and needed a biopsy. She attempted to shop responsibly and was quoted $1,400 by her hospital’s price estimator, but she ended up with a charge of $18,000—more than $5,000 of which she was forced to pay out-of-pocket.
The Lower Costs, More Transparency Act makes hospital pricing clear and understandable to patients. It requires hospitals, insurance companies, labs, imaging providers, and ambulatory surgical centers to publicly list the prices they charge patients, building upon the Trump administration price transparency rules.
RIGHT NOW: Patients don’t know how much they’ll be charged until AFTER they receive care. Take for example Nikki Pogue, who was overcharged $11,000 by a hospital that attempted to bill her for a service she didn’t receive. According to testimony before the Energy and Commerce Committee, “She had no idea what this charge was and did not get any transparency or explanation from the hospital. She spent the next five months working to decipher the bill on her own, only to discover the hospital had miscoded her Emergency Severity Index and severely over-charged her.”
The Lower Costs, More Transparency Act brings patients accurate and accountable pricing information BEFORE they seek care. It empowers patients to shop for health care and make informed decisions by providing information about the cost of care, treatment, and services.
RIGHT NOW: Patients are charged more for the same medicine provided by the same doctor to the same patient, if the doctor’s office is purchased by a hospital. This happened to Kyunghee Lee, a senior citizen from Ohio, who saw the cost of her annual steroid injection increase from $30 to $354.68. Her bill increased by more than 1,000 percent just because her doctor’s office was purchased by a bigger hospital system, despite the fact that she was receiving the same shot, from the same doctor, in the same building.
The Lower Costs, More Transparency Act ensures that patients pay the same price for the same drugs regardless of where those drugs are administered by preventing out-patient facilities owned by hospitals from charging more for a drug than a non-hospital-owned doctor’s office.
RIGHT NOW: Consolidation in the health care sector drives up pricing by eliminating competition and limiting choices for patients, in many cases, those battling cancer. Earlier this year, the Energy and Commerce Committee heard testimony from the Leukemia and Lymphoma Society (LLS), who described the Committee’s work on transparency and health care costs as “urgent” for the 180,000 Americans who are diagnosed with blood cancer each year.
According to LLS, “We are encouraged by many of the proposals the Committee is considering today to promote healthcare competition and encourage meaningful transparency. We share these goals because we believe that improved competition and transparency have the potential to realign incentives to achieve improved health outcomes while lowering costs for patients, consumers, employers, and taxpayers.”
The testimony also noted the importance of site neutral drug policies for cancer patients given the proportion of chemotherapy infusions to Medicare beneficiaries in higher-cost hospital-owned outpatient facilities, which were once lower-cost independent physician practices, has increased from 15.8 percent in 2004 to 45.9 percent in 2014. Further, LLS noted, “Equalizing payments between these sites of service would weaken the incentive for provider consolidation, which would also produce long-term cost savings across insurance types and give patients additional options for their care.”
The Lower Costs, More Transparency Act helps cancer patients afford their care by increasing transparency and competition in health care.
RIGHT NOW: Vague bill practices leave patients on the hook for bills they never saw coming. Last year, Mike Lauze spent one hour in an O.R. undergoing eye surgery. His bill included three separate facility fees totaling $7,800 and professional fees totaling $6,200. In the words of Energy and Commerce Chair Cathy McMorris Rodgers, “Why are three facility fees necessary for one hour of surgery in one O.R.? I do not know. But I do know that the system must be simpler, more affordable and work better for patients.”
The Lower Costs, More Transparency Act extends price accountability to outpatient surgery centers by requiring price transparency for services.
It’s time to change the status quo that is hurting patients and make health care more affordable. That is why the bipartisan Lower Costs, More Transparency Act has a singular goal in mind—lowering costs for patients through increased price transparency and competition.
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