A thread on price transparency and the new CMS rule on hospital chargemaster prices... @larry_levitt @PaulSisson
Transparency is important, especially around prices, which we know have an outsize impact on overall spending. See this @JAMA_current study by @ashishkjha @ipapanicolas @lwoskie. jamanetwork.com/journals/jama/…
Chargemasters = one data point for transparency.
No, chargemasters are not perfect. See @MHHmeyer's piece in @modrnhealthcr. modernhealthcare.com/article/201901…
That said, they are definitely NOT meaningless.
Judges and arbiters use chargemasters to determine one of the Gould factors — what is "usual, customary, and reasonable" (UCR). These inflated list prices pull up that calculation. lawlink.com/research/CaseL…
UCR = the amount insurers pay providers they don't have contracts with. For example, the UCR amount is used when someone with insurance ends up in an ER that is out of network.
Existing Knox Keene protections and recent out-of-network (“surprise”) billing law for consumers don’t address the issue.
This can increase premiums for anyone in California that has insurance through their employer, #CoveredCA, etc.
One option? Capping billed charges at 125% of 👏negotiated 👏rates. See nytimes.com/2018/09/05/opi… @uscprice @SchaefferCenter /end thread
