Senators ask what’s holding up price transparency in healthcare

A group of U.S. senators has sent a letter to dozens of healthcare industry groups asking for more information on what price and quality information is available to consumers and what regulations may be getting in the way of greater price transparency.

“When asked more specifically about their concerns with health care, nearly two-thirds of Americans say it is too difficult to find out what medical care costs,” the six senators wrote. “In virtually every other industry, consumers are able to price shop, compare quality, and then decide what product best fits their needs. In health care, the lack of information and the inability to access it hurts patients and prevents normal market forces from driving competition, lowering prices, and improving quality.”

Sen. Bill Cassidy, MD, R-Louisiana, is leading the initiative, along with Sens. Michael Bennet, D-Colorado; Tom Carper, D-Delaware; Chuck Grassley, R-Iowa; Claire McCaskill, D-Missouri; and Todd Young, R-Indiana.

Cassidy has previously expressed interest in pursuing price transparency legislation this year, but state-level efforts have run into two major issues—patients aren’t making use of the tools which are available and hospitals, physicians and other stakeholders have fought efforts to make the costs of the services they provide publicly available. This is despite industry recognition that encouraging consumerism in healthcare should be a priority as the prevalence of high-deductible health plans shifts more costs onto patients.

To speed up those efforts, the senators asked groups like the American Hospital Association, American Medical Association, Blue Cross Blue Shield and the Ambulatory Surgery Center Association to answer these questions:

  • What information is currently available to consumers on prices, out-of-pocket costs, and quality?
  • What information is not currently available, but should be made available to empower consumers, reduce costs, increase quality and improve the system?
  • What role should the cash price play in greater price transparency? How should this be defined?
  • What are the pros and cons of different state approaches like those in place in Maryland or Colorado? What is the best quality and price information to collect for consumers and businesses?
  • Who should be responsible for providing pricing information and who should share the information with consumers?
  • What role should all-payer claims databases play in increasing price and quality transparency? What barriers currently exist to utilizing these tools?
  • How do we advance greater awareness and usage of quality information paired with appropriate pricing information?
  • How do we ensure that in making information available we do not place unnecessary or additional burdens on health care stakeholders?
  • What current regulatory barriers exist within the health care system that should be eliminated in order to make it less burdensome and more cost-efficient for stakeholders to provide high-quality care to patients?
  • How can our health care system better utilize big data, including information from the Medicare, Medicaid, and other public health programs, to drive better quality outcomes at lower costs?
  • What other common-sense policies should be considered in order to empower patients and lower health care costs?

The senators asked for groups to respond by March 23.