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The Health 202: Hospitals drag feet on new regulations to disclose costs of medical services

with Paige Winfield Cunningham

Hospitals are now required to disclose the prices they secretly negotiate with insurers.

But many are dragging their feet on the new regulations, which were passed under President Donald Trump and could very well stay in place under President Biden.

The rules went into place Jan. 1, but hospital compliance is spotty.

“Hospitals are playing a hide-and-seek game,” said Ge Bai, an expert on health-care pricing at Johns Hopkins Bloomberg School of Public Health. “Even with this regulation, most of them are not being fully transparent.”  

Hospitals lost a bruising court battle last year to stop the rules, which require them to publish a list of prices for goods and services. The point is to bring more transparency to prices for medical goods and services — information that has long been inaccessible to consumers. The new rules were a centerpiece of Trump’s promise to inject more price transparency in the health-care system and curb surprise billing.  

But Nisha Kurani, a policy analyst at the Kaiser Family Foundation who is tracking hospital responses to the new rule, said she’s seen the full gamut. 

MedStar in Washington posted its prices in an Excel sheet on its website, but other hospitals only posted price estimates, uploaded files in difficult to use formats, or promised to release information only after someone inputs their insurance, Kurani said. 

A Gothamist investigation found that only one of five major New York hospitals posted a list of their negotiated services to their website, and even then, not for all procedures. The fine for not complying with the new rules — $300 a day — is a drop in the bucket for many hospitals. 

The rules probably aren’t going away anytime soon. 

The Biden administration hasn’t taken any public position on the rules — and right now, officials are focused on reversing dozens of other Trump administration regulations they believe are damaging to health insurance and costs in the United States.

Revising the hospital transparency rules — if that’s even something the new administration wants to do — would likely be far down on the priority list, despite heavy lobbying by the hospital industry to suspend enforcement of the new rule. 

Plus, price transparency is broadly popular among the public and was one of the planks of a joint health policy plan developed by a task force Biden formed with Sen. Bernie Sanders (I-Vt.) after the 2020 primary elections. 

The American Hospital Association says staff who would help with compliance are stretched thin.

Molly Smith, the association's group vice president for public policy, said many of the staff members who would normally be tasked with compiling and formatting the price data are the same people being asked to help set up patient registries and vaccine tracking systems in response to the pandemic.  

“We’ve got a lot of hospitals that are at or beyond capacity,” Smith said.  

A lawyer for the hospital association said that it is considering petitioning its legal case to the Supreme Court. Meanwhile, the lobbying group has been pushing the Biden administration to suspend enforcement of the new rule. 

Consumer advocates like the transparency rules designed to protect patients and drive down health-care costs.

“In the past there was absolutely no power for the consumer. It was like highway robbery being committed every day by the health-care system,” said Cynthia Fisher, head of the nonprofit Patient Rights Advocate, which pushes for price transparency.  

But now, Fisher says, “it's the American consumer who is going to drive down the cost of care.”

But the effect might be modest.

Experts in health-care economics hotly debate whether the price transparency rules will, in fact, drive down costs. Even those who support the changes say the effect might be incremental.

“I don’t think it’s going to be an earthquake in terms of pricing, but it’s a first step in the right direction,” said Bai.  

There are several reasons the new price transparency rule may not have a massive effect on hospital prices. Perhaps the biggest, and one often cited by the hospital lobby, is that most Americans are not going to pay the negotiated price for a procedure. Instead, they are likely to pay co-pays or coinsurance that amount to a fraction of this price. 

This isn’t always true, of course. Those with high-deductible plans may pay the negotiated rate, and for those without insurance paying out of pocket, it can be helpful to get a peek behind the sticker price. But even for these patients, it may be challenging to extract useful information from unwieldy spreadsheets full of obscure billing codes. 

Bai said that she is hopeful that third parties may make some of the pricing information easier for consumers to use. And some self-insured employers may start identifying cheaper providers and incentivizing patients to use them. The rules also require hospitals to provide cost-sharing estimates for commonly used procedures in an easily navigable format. 

Still, price competition works only if there are players to compete. 

The market for health care has become increasingly consolidated as hospitals merge and buy up physician practices. If a hospital is the only health-care provider in town, then there’s not a whole lot patients can do about high prices, even if they think they’re unfair. 

“I don’t think transparency will fundamentally change the power balance between the payer and the hospital in many markets,” Bai said. 

Ahh, oof and ouch

AHH: Deborah Birx says Trump received a “parallel set of data” on the coronavirus.

The former White House coronavirus response coordinator told CBS News’s “Face The Nation” that she saw Trump presenting graphs about the coronavirus that she did not help make. Someone inside or outside of the administration, she said, “was creating a parallel set of data and graphics that were shown to the president.”

Birx also said that there were people in the White House who believed the coronavirus was a hoax and that she was one of only two people in the White House who routinely wore masks.

Birx was often caught between criticism from Trump, who at one point called her “pathetic” on Twitter when she contradicted his more optimistic predictions for the virus, and critics in the scientific community who thought she did not do enough to combat false information about the virus from Trump, The Post’s Meryl Kornfield reports.

“Colleagues of mine that I’d known for decades — decades — in that one experience, because I was in the White House, decided that I had become this political person, even though they had known me forever,” she told CBS. “I had to ask myself every morning, ‘Is there something that I think I can do that would be helpful in responding to this pandemic?’ And it’s something I asked myself every night.”

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told the New York Times that Trump repeatedly tried to minimize the severity of the virus and would often chide him for not being positive enough in his statements about the virus. 

Fauci also described facing death threats as he was increasingly vilified by the president's supporters. “One day I got a letter in the mail, I opened it up and a puff of powder came all over my face and my chest,” he said. The powder turned out to be benign.

OOF: A gout drug shows promise in treating covid-19, but some scientists are skeptical.

A news release from the Montreal Heart Institute, a Canadian research group, touted a new study that found that colchicine, a drug used to treat gout, reduced the risk that patients with covid-19 would be hospitalized.

“But outside experts said the data provided were too limited to draw conclusions, leading to discussions of the risks of conducting science via press release, instead of in more detailed manuscripts in peer-reviewed journals. All hoped that colchicine, a cheap and globally available generic medicine with manageable side effects, would prove to be beneficial,” Stat News’s Matthew Herper reports.

The Montreal Heart Institute said the rate of hospitalization for patients who received colchicine was 21 percent lower compared with patients who did not in a double-blind study enrolling 4,488 patients. But the news release said that the difference between the placebo group and those receiving the drug “approached" but did not reach statistical significance. Some scientists have raised additional concerns about the lack of data included with the news release.

“I’m not, ‘Oh, I don’t buy it’,” Ashish Jha, dean of the Brown University School of Public Health, told Stat News. “It’s possible. There’s enough plausibility here. This could be a real finding, and if it is that would be great. But this press release doesn’t get us there.”

Nahid Bhadelia, an infectious diseases physician at Boston University:

Isaac Bogoch, an infectious disease physician with the University of Toronto and Toronto General Hospital:

OUCH: Centrist lawmakers from both parties are lobbying Biden for a more targeted coronavirus relief bill.

“The discussion came on a private Zoom call between key centrist lawmakers of both parties and Biden administration officials led by National Economic Council Director Brian Deese. It was an early test for whether Biden’s relief plan has a chance of getting the kind of support it would need to pass Congress with bipartisan backing,” The Post’s Erica Werner and Seung Min Kim report.

The president’s $1.9 trillion coronavirus relief plan includes money for another round of $,1400 relief checks, as well as funding to help schools reopen and emergency unemployment benefits.

The proposal also includes funding to spur vaccine distribution, a measure that the lawmakers identified as a top priority. Amid the spread of new, more infectious coronavirus variants, the speed of vaccine distribution will have major public health consequences.

“Biden faces a difficult balancing act in pushing the proposal into law. The types of concessions that might be necessary to win support from Republicans like [Maine’s Sen. Susan] Collins and [Utah’s Sen. Mitt] Romney would likely make the proposal smaller and less palatable to liberal lawmakers. Liberals are pushing for Biden to use special Senate rules to force through the package with only Democratic votes, but doing that would undercut Biden’s pledges to seek unity and bipartisan outcomes,” my colleagues report. 

Race to vaccinate

Biden’s vaccine timeline is aggressive compared with other countries.

Some critics have noted that the incoming administration’s target of vaccinating 100 million people in 100 days does not represent a significant increase in the pace of vaccinations, compared with what the country saw in the final days of the Trump administration. That’s led for some to call on Biden to set a more ambitious target.

In international context, however, the U.S. pace of vaccinations does not seem so slow. 

“Though differences in population, logistical capacity and data transparency, along with different levels of vaccine vetting and effectiveness between vaccine types, make it hard to compare vaccination campaigns across countries, the United States is near the top of the pack, behind some of the fastest countries to vaccinate, including Israel and Britain, but ahead of most of the rest of the world,” The Post’s Emily Rauhala and Adam Taylor report.

The aggressive vaccination pace in the United States is, in part, the result of quickly snapping up vaccine supply. Many low- and middle-income countries have ended up at the back of the line when it comes to vaccine supply. 

But even with the United States’ relatively privileged position in receiving vaccine doses, supply could still be a limiting factor. Rochelle Walensky, the new director of the Centers for Disease Control and Prevention, told “Fox News Sunday,” that it might be difficult for the administration to accelerate beyond 100 million shots in 100 days due to supply limitations. 

More in coronavirus

  • The Centers for Disease Control has said that patients who have received their first dose of the coronavirus vaccine can schedule their second dose up to six weeks later, although the preference is still for a recommended interval of three weeks for the Pfizer-BioNTech vaccine and four weeks for Moderna’s, The Post’s Lena H. Sun reports. In “exceptional circumstances,” the agency advised that people may switch from one of the authorized vaccines to the other between the two shots.
  • The Biden administration is considering using the Defense Production Act to supercharge production of a special type of syringe that is more efficient in extracting coronavirus doses. These syringes are often able to get six full vaccine doses out of vaccine vials from Pfizer-BioNTech, compared to the expected five doses. But BD, the world’s largest syringe manufacturer, warns that it will take considerable effort to ramp up supply of the niche syringes, The Post’s Christopher Rowland reports
  • Many parts of the United States seem to have dodged a Christmas coronavirus surge, as cases and hospitalizations appear to be stabilizing. Still, experts say that that the cases are plateauing at a dangerously high level and new coronavirus variants could exacerbate the threat, The Post’s Fenit Nirappil reports.

At the White House

Biden commissions a new White House physician.

Biden has tapped Kevin O’Connor, who has served as his primary care physician since 2009, replacing Sean Conley “in a role that became a source of controversy under former President Donald Trump’s four years in the White House,” ABC's Molly Nagle reports. “It's not unusual for a new president to select their personal physician for their term, However, O'Connor will take on the job in the medical unit that faced a crisis of credibility under Trump following rosy readouts of physicals and misleading information about his COVID-19 treatment.” 

O’Connor was originally appointed physician to the vice president during the Obama administration “and was chosen by Biden for the new role due to their long history, and personal relationship, according to a White House official,” per ABC.  

Elsewhere in healthcare

More insurers are adding food and nutrition coverage as a way to improve health.

“Benefits experts say insurers and policymakers are growing used to treating food as a form of medicine that can help patients reduce blood sugar or blood pressure levels and stay out of expensive hospitals,” Tom Murphy of the Associated Press reports. “More plans are paying for temporary meal deliveries and some are teaching people how to cook and eat healthier foods.”

So far the push has happened mostly within government-funded programs such as Medicaid and Medicare advantage. Oscar Health, for instance, surveyed some of its Medicare Advantage customers at the start of the pandemic to find out if they had enough to eat. When it found that nearly 3 out of 10 did not, the insurers arranged temporary grocery deliveries.

Sugar rush