AHA Among Groups Opposing Price Transparency in Info-Blocking Rule

June 11, 2019

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Source: Modern Healthcare

Healthcare groups including the American Hospital Association came out strong against a suggestion that the Office of the National Coordinator for Health Information Technology require providers to disclose price information as part of its proposed rule.

The ONC in February released its long-awaited information-blocking proposal as a companion to the CMS’ interoperability proposed rule. The ONC’s rule outlines how regulators will require providers to share health data with patients, as well as steps to discourage healthcare organizations from creating barriers to data exchange.

But what data is included in that mandate has proved a point of contention.

In its proposal, the ONC asked stakeholders to weigh in on whether providers should offer patients information on how much they would be charged for certain services. “ONC has a unique role in setting the stage for such future actions by establishing the framework to prevent the blocking of price information,” the rule reads.

However, adding price information to the broader umbrella of health data that’s required to be shared with patients would go “well beyond what Congress intended and would seriously harm patients, hospitals and other healthcare providers,” the AHA wrote in a letter to the agency, arguing that the mandate extends past the goals of the 21st Century Cures Act. The data-blocking rule was a provision of the 21st Century Cures Act.

One of the AHA’s concerns is that publicly sharing price information would disrupt negotiations with payers.

Blue Shield of California raised a similar concern in a letter to the ONC, suggesting the agency should solely focus on providing patients with information on out-of-pocket costs, rather than on providers’ negotiated rates with health plans.

“We urge ONC to ensure any future proposals related to pricing information exclude plans’ proprietary pricing information and protect market negotiations between health plans and providers,” the health insurer wrote.

Other groups were more supportive of the idea, although they requested the ONC separate any rulemaking on price information from the information-blocking proposal.

The federal Health Information Technology Advisory Committee in May cautioned that tying price transparency to the information-blocking proposal would have an “unintended consequence of slowing down the finalization of the current ONC rule,” and recommended the ONC convene a price-transparency task force to consider the idea.

“As a task force, we absolutely agreed that we want to enable price transparency,” Andrew Truscott, co-chair of HITAC’s information-blocking task force and Accenture’s managing director for health and public service, said at the May meeting. “We believe that (price transparency) needs to be given a focus.”

Software company Wolters Kluwer voiced a similar sentiment in a letter to the ONC.

“We generally support including price information within the scope of (electronic health information) for purposes of information blocking, but not in the short-term,” the company wrote, noting price information is difficult to calculate, as it it requires knowing details of an individual patient’s insurance status.

“Factors such as insured status, in-network status, insurance deductibles, insurance co-pays and co-insurance add significant complexity to presenting usable information on price and until those factors are adequately addressed, it makes little sense to include price within the definition of EHI,” Wolters Kluwer wrote.

However, a review of individual comments submitted to the ONC—many of which come from patients sharing stories about expensive medical treatments—suggested there is demand for improving how providers share information on price. One submission from an anonymous commenter simply reads: “We want price transparency!”

Holy Name Medical Center in Teaneck, N.J., also expressed support for the inclusion of price information, arguing that current guidelines related to chargemaster prices are “woefully insufficient” as “the public should have the right to see which hospital systems and healthcare providers are driving higher costs.”

“The current healthcare market is a complex system of secret deals and discounts between insurance companies and healthcare providers,” the hospital wrote to the ONC. “In order to truly lower costs for consumers, we need greater transparency in the marketplace.”

 

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