Hospitals Battle Cost Transparency Rules

September 29, 2017

Florida hospitals are battling back against a pair of proposed “transparency” rules requiring hospitals and ambulatory surgical centers to provide information to patients and prospective patients about potential costs of treatment.

A statewide group that represents most hospitals filed an administrative challenge last week that maintains the rules go beyond what is authorized by law.

The Florida Hospital Association also maintains the state underestimated the fiscal impact of the proposed rules and contends the rules require legislative approval before implementation because they would increase costs to hospitals and ambulatory surgical centers by more than $1 million over a 5-year period.

Agency for Health Care Administration spokeswoman Shelisha Coleman said the state doesn’t comment on pending legal matters and declined further comment. The agency filed a motion Tuesday arguing that an administrative law judge should dismiss the case.

The Florida Hospital Association represents more than 200 hospitals and health systems across the state. Many of those facilities also own or operate ambulatory surgical centers. The challenged rules — one aimed at hospitals, the other at ambulatory surgical centers — would require the facilities to provide information both online and personally to patients, prospective patients and responsible parties.

In the challenge, the association contends that what are known as “statements of estimated regulatory costs” developed by AHCA show a “minimal” fiscal impact but that the costs are “substantial.”

“For example, and without limitation, the technology related development costs associated with including information on facility websites that could instead be included on a site maintained by an agency vendor are well in excess of $1 million,” the challenge said.

The case marks another showdown between hospitals and the administration of Gov. Rick Scott, a former health-care executive.

Following a bruising 2015 legislative session that was forced into overtime after a divisive battle over Medicaid expansion, Scott assembled a blue-ribbon panel to examine the costs of health care at Florida hospitals.

The following session, Scott made health-care “transparency” one of his top priorities with the Legislature. The governor initially wanted to cap what hospitals could charge patients. Hospitals that exceeded those price caps could have been prosecuted by the state attorney general.

Though the Legislature was supportive of “transparency,” it didn’t embrace caps or criminal penalties.

Ultimately, lawmakers passed and Scott signed into law a bill that requires hospitals and ambulatory surgical centers to provide access to searchable information on their websites about “service bundles.” The information would give patients and potential patients access to data about estimated average payments received — excluding Medicare and Medicaid — and estimated payment ranges for each service bundle, by facility, facilities within geographic boundaries, and nationally. The facilities would be required to disclose that the information is an estimate of costs and that actual costs would be based on services actually provided to patients.

Agencies approve rules to carry out the details of state laws.

The hospital association maintains in its challenge to the transparency rules that a lower-cost alternative would be to allow hospitals and ambulatory surgical centers to post price information through a hyperlink that would allow patients and potential patients to connect to a site maintained by the agency.

David Ashburn, outside general counsel for the association, noted in the administrative challenge that the 2016 law allows for hospitals to meet the posting requirements through a hyperlink and that in meetings with the industry over the summer, AHCA staff assured hospitals that would be the case.

Ashburn told The News Service of Florida on Thursday that the industry isn’t opposed to “transparency,” and the challenge addresses “a few very specific terms of the rule to ensure the hospitals will be in compliance.”

by Christine Sexton, The News Service of Florida

Comments

4 Responses to “Hospitals Battle Cost Transparency Rules”

  1. tg on September 30th, 2017 8:12 am

    If you have to go to the hospital without insurance they will own you but insurance pays about a third of billing.

  2. Bewildered on September 30th, 2017 6:30 am

    They are free to charge whatever they please. I had two identical x-rays done – one at a hospital which charged $1000 to the insurance company with a $ 50 co-payment and the second one at doctors offices a couple of months later which was billed at $100 with a $45 co-payment. If the insurance companies dont blink an eye to pay 10 times the amount necessary, i doubt that the consumers can do anything about the costs.

  3. Charlie Mike on September 29th, 2017 10:14 pm

    I’m sure there is a business out there that tells you the price of the product only AFTER you purchase and are liable for it. Just can’t think of one at the moment.

  4. anne 1of2 on September 29th, 2017 11:26 am

    How dare we ask the price of medical treatments! Who do we think we are anyway?
    I’ve been telling office employees on the phone and those sitting at desks not to even try to talk down to me when I know exactly what I am asking. Where else are we made to feel it is none of our business to ask how much will this cost? They prey on people every day of the week. We all need to be questioning what a procedure will cost, what part will be left for the patient to pay. Look at the length of this report,. it is meant to discourage people from even reading it.. A very few specific terms is exactly what they need.

Written by William Reynolds · Filed Under News