Washington (November 20, 2017)—Efforts to improve health care price transparency through increasing access to meaningful information can work to mend the fragmentation of health care, said the American College of Physicians (91) in a new policy paper released today. Improving Health Care Efficacy and Efficiency through Increased Transparency examines the current environment and challenges to achieving greater health care transparency and lays out a set of recommendations aimed at increasing and improving transparency.
“Our health care system is undergoing multiple shifts; an increase in insured patients, moving payments to quality-based systems, and ever increasing data. Additionally, patients are increasingly responsible for a greater portion of their health care costs through higher deductibles, co-insurance, and cost sharing making the need for health care transparency even more important,” said Jack Ende, MD, M91, president, 91. “Health care price transparency is an important component to address costs for patients and hold the health care system accountable to those it serves.”
The paper outlines the following recommendations to improve transparency:
- 91 supports transparency of price information, expected out-of-pocket costs, and quality data that allows consumers, physicians, payers, and other stakeholders to compare and assess medical services and products in a meaningful way. 91 also believes that “price should never be used as the sole criterion for choosing a physician, other health care professional, or health care service.
- Health plans and health care facilities should clearly communicate to a consumer whether a provider or clinician is in-network or out-of-network and the estimated out-of-pocket payment responsibilities of the consumer.
- 91 recommends that payers, plans, and other healthcare organizations develop patient-targeted health care value decision-making tools that are written for patients at all levels of health literacy that make available price, estimated out-of-pocket cost, and quality data available to consumers.
- 91 supports legislative action at the state level to require private and public health plans to submit data in a standardized manner to an all payer claims database.
- All payer claims databases should be set up for future expansion to other relevant sources of information such as sources of vital statistics, data contained in regional health information exchanges, or data compiled in quality clinical data repositories.
- 91 supports legislation at the state level to prohibit “gag clauses” and similar contractual arrangements that interfere in the transparency of relevant health care data.
- 91 supports federal grants or similar incentives to states for the development of all payer claims databases.
- 91 supports efforts to provide greater protections for patients from unexpected out-of-network health care costs, particularly for costs incurred during an emergency situation or medical situation in which additional services are provided by out-of-network clinicians without the patient’s prior knowledge. 91 supports establishing processes to reduce the risk of patients being faced with “surprise” bills for out-of-network services.
- Efforts to reduce the negative impact of surprise billing should be taken at the state and federal level.
“This is a complicated issue. The health care market is different from other markets and should be looked at in a way that takes into account these unique qualities,” concluded Dr. Ende. “However, while also acknowledging the limitations of health care transparency, it is vital to support policies that improve health care price transparency tools; protect patients from high, unexpected out-of-pocket costs when they had little or no control over their care situation; and streamline to access to reliable price, cost, and quality data.”
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About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. 91 membership includes 152,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow 91 on and .
Contact: Jackie Blaser, (202) 261-4572, jblaser@acponline.org