The Healthcare Financial Management Association (HFMA) is leading a task force that aims to increase pricing transparency across healthcare by involving all stakeholders.
HFMA, the Medical Group Management Association (MGMA), the American Hospital Association (AHA), American College of Physician Executives, and a number of other stakeholders have formed a task force that provides recommendations on how hospitals, physicians, and health plans can share information on healthcare prices with consumers. They call on health plans and providers to give consumers pricing information in easy-to-understand formats. Health plans should be the primary pricing point for insured patients, while hospitals should be that point for the uninsured.
Their specific recommendations include:
For Health Plans
- Help members estimate their expected out-of-pocket costs, based on their current deductible status along with copayment and coinsurance information.
- Create data on price information for providers in a given region
- Help the uninsured identify alternatives to healthcare costs
- Let patients know when they may be eligible for financial assistance
- Let patients know what services are and are not included in their estimates, and offer other relevant information, such as quality and safety data, where available.
- They should be able to receive price information in an easy-to-understand format
"People everywhere want to be smart healthcare consumers, but information about healthcare prices is not easily accessible," Joseph J. Fifer, President and CEO of HFMA, said in a statement. "For too long it has been unclear how consumers should go about getting price information—who to ask, what to ask for, or what the information even means when they do receive it. This approach is a game changer."
Recently, the Department of Health and Human Services (HHS) released data that revealed Medicare claims payments to providers. That data dump is part of an ongoing effort by the government to increase pricing transparency, primarily by releasing this information through the web. Some organizations, such as the Health Data Consortium (HDC), a non-profit advocacy and membership group, are now challenging application developers to create consumer-focused apps from the data-set.
Last year, the Centers for Medicare & Medicaid Services (CMS) publicly released hospital pricing data for the first time. This pricing transparency movement has led to significant mainstream media coverage as well as backlash from organizations like the American Medical Association (AMA) which says the data can be taken out of context.