Healthcare Reform - It Costs WHAT???
February 9, 2023
Good Day Healthcare Advocates
I am so thankful for all of you and for the actions you take to move us towards a universal healthcare system. Some of the topics in work are:
The current state of healthcare providers and the potential impact of Universal Healthcare on them
How Universal Healthcare affects the insurance industry (it’s not what you think)
Rural healthcare challenges
Hospice Fraud revisited - this is worse than was reported
Please send topics to me via the chat button and I will research and report. If you need assistance in other ways, lectures, presentations, etc. Just let me know, I’m happy to help.
Current State - It Costs WHAT???
The US Government agency, Health and Human Services (HHS) and the Center for Medicare and Medicaid Services (CMS), has a lot to say about the way healthcare is delivered in the US. This is because they hold the Medicare/Medicaid big stick. If you want reimbursement for those patients from us, you must comply.
HHS/CMS implemented a price transparency regulation on January 1, 2021. Hospitals are required to post prices online in a user-friendly format and for full compliance, in a machine readable format (xml or JSON or the like). They are to include standard and discounted cash prices for all items and services for all health insurance plans. They are also to have standard charges on display for 300 shoppable services.
Now there are a lot of hospitals in the US, 6093, to be exact. How many comply? According to the Fourth Semi-Annual Hospital Price Transparency Report t 2000 hospital websites were checked for compliance between December 10, 2022 and January 26, 2023.
RESULTS
Fully Compliant 489 (24.5%)
Non Compliant 1506 (75%) did not publish a machine readable file of standard charges,
No Posting on line 116 (6%)
Pricing data missing or incomplete 996 (49.8%)
As an ex software engineer not having a machine readable form is easy to fix. HHS even has an instruction booklet that explains how to do it. (MS Office makes it easy).
The real problem is that about ¾ the hospitals surveyed chose to be noncompliant. Is there a penalty? You bet. You can find it here. It states that small hospitals can be penalized $300/day up to $109,500/year and larger ones up to $5550/day up to $2,007, 500/year.
Ok, sounds like HHS/CMS should be owed a lot of money, but in the last 2 years they have only issued two civil monetary penalties.
The problem is that no one takes the rule seriously because ¾ of the hospitals are in violation and virtually no one has to pay a penalty for violations. It’s good to have rules but if you don’t enforce them it does no good. Perhaps it was the pandemic that overloaded the hospitals into noncompliance, perhaps HHS/CMS doesn’t have the enforcement staff in place. If you create a rule with penalties you should account for the enforcement of the penalties for non-compliance at the start. Of course, this problem disappears with Universal Healthcare when reimbursement is well defined, and there are no co-pays/deductibles for patients.
What You Can Do
You can cut and paste the text below into an email to your representatives and the White House or use it in a phone call to them (feel free to personalize it) or use RESISTBOT to send an email to the White House, and your representatives in Washington D.C.
RESISTBOT Text “SIGN PMWCTD” to 50409
I am your constituent. According to the Fourth Semi-Annual Hospital Price Transparency Report of 2000 hospitals 3/4 of those surveyed are non-compliant. These rules on transparency began in 2021 and are still not followed. Small hospitals can be penalized $300/day up to $109,500/year and larger ones up to $5550/day up to $2,007, 500/year. In the last 2 years only 2 hospitals have been penalized. I want you to send a letter to HHS head Xavier Becerra and CMS Head Chiquita Brooks-LaSure and ask them to implement their own rules. If they need help or resources for enforcement they should say so.
While you’re at it I want to remind you that this kind of shenanigans would not occur if we had a Single Payer Universal Healthcare with clear reimbursement rates. Work on that too!
EXTRA Credit
S.4293 - Pharmacy Benefit Manager Transparency Act of 2022 is flawed. It addresses many of the PBM problems but it calls for PBMs to send rebates back to health insurance companies or patients. We know that since the three largest PBMs are aligned with health insurance companies that the money will go to them and the consumer is again cheated and no better off. We asked senators to support it previously but with this flaw we have to ask them to fix it.
USE RESISTBOT to send the Email below to your senators.
Text “Sign PBKCCQ” to 50409 to send this email
I am your constituent. I am disappointed to see that S. 4293 the Pharmacy Benefit Manager Transparency Act of 2022 allows PBMs to send their shady rebates to health insurance companies instead of consumers. Change the bill so that consumers get the rebates not the insurance companies. The 3 largest PBMs are all vertically aligned with health insurers. This allows patients to still be cheated. Please fix this now. Thank you. BTW If we had Single Payer Universal Healthcare I wouldn’t be bothering you with this.
Resources
Contact Federal Representatives
Representatives
https://www.house.gov/representatives/find-your-representative
Senators
https://www.senate.gov/senators/senators-contact.htm
White House
https://www.whitehouse.gov/contact/
Healthcare Advocacy Reading List
League of Women Voters Health Care Reform Toolkit
https://lwvhealthcarereform.org/
Physicians for a National Health Plan - Business Case for Universal Health Care
https://pnhp.org/news/more-on-a-business-case-for-universal-health-care/
Done!