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HFMA: Healthcare Pricing Transparency a Shared Responsibility

Christopher Cheney, for HealthLeaders Media, April 30, 2014

'Center Stage Without a Script'
The need for greater transparency is widely viewed as pressing. "We're giving consumers keys to a new car, but you wouldn't give anyone a new car without driver's education," Robin Gelburd, president of New York, NY-based FAIR Health Inc., said in a phone interview.

FAIR Health is a not-for-profit corporation established in 2009 as part of a settlement agreement between the state of New York and insurers over out-of-network reimbursement practices. According to the organization's website, the organization was formed to manage, improve, and expand the claims database that supported claims adjudication and to enhance its transparency, objectivity, reliability and accessibility."

FAIR Health maintains an independent database of healthcare claims information on 140 million "covered lives," Gelburd said.

"In the past, the consumer was like the chorus line in a Broadway show," she said. "Now they have been thrust to the center of the stage with the spotlight on them. They can't be center stage without a script."


Christopher Cheney is health plans editor at HealthLeaders Media.
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4 comments on "HFMA: Healthcare Pricing Transparency a Shared Responsibility"


Jack Durbin (4/30/2014 at 1:57 PM)
I would add to the information shared about pricing transparency the tension between services delivered at a hospital compared to a clinic or outpatient center. There are significant added costs to provide a 24/7 full service facility compared to a M/F day time service. Even for patients with insurance, increasing deductible costs are making patients select the point of care with the lowest cost as that is the usual basis for their out-of-pocket expense. What they don't realize is that in smaller communities, these choices may make the difference in the scope of services that the local hospital may continue to be able to offer.

Fritz Stephens-Tiley (4/30/2014 at 12:21 PM)
As usual this article has missed the boat. The notion of "price" transparency is irrelevant when you have providers setting their "prices" at, in most cases, over 200% of their costs. Cost data is freely available via CMS cost reports that hospitals are required to submit annually. The health care industry is a cash cow for those willing to exploit it. Insurance companies are no better when they consistently do a poor job of negotiating with providers for more realistic reimbursement rates. They simply pass any rate increases to their members in annual premium hikes. The "Free Market" has failed us.

Cody (4/30/2014 at 10:12 AM)
While pricing transparnecy is the responsiblity of the provider, once pricing is provided it's the responsibility of the patient to pay for their care. A lot of what is being missed in what is being described in most articles related to hospital pricing is the fact that a majority of patients don't meet their payment obligations. Thus the ever increasing amount of hospital bad debt and uncompensated care. In addition, not often mentioned is the self pay discounts, charity and other forms of discounts provided to patients. As with most people that have bought a car, you rarely pay the "sticker price".