Healthcare spending in the US is significant, and it grew by 9.7% in 2020, reaching $ 1 trillion or $12,530 per capita. Healthcare spending accounted for 19.7% as a share of the nation’s Gross Domestic Product (Glied, 2021)(Nursing Leadership Health Policy Comprehensive Essay Example). Health care cost reduction is an ongoing agenda that has seen policymakers propose various interventions, including price transparency. The policymakers initiated and actualized price transparency policies that require healthcare providers to post billing information for the consumers to understand the pricing strategy. However, the policy has not achieved its purpose, and the billing process remains elusive. The paper evaluates the policy and makes recommendations for change to increase clarity regarding the billing process among consumers.
Nursing Leadership Health Policy Comprehensive Essay Example
Legislative Proposal
The current price transparency policy requires hospitals to “provide clear, accessible pricing information online about items and services they provide in two ways: 1. As a comprehensive machine-readable file with all items and services. 2. In a display of shoppable services in a consumer-friendly format.” The proposed policy change requires hospitals and insurers to post other variables affecting the pricing and the negotiations between insurance providers and hospitals that affect the final price consumers are expected to pay.(Nursing Leadership Health Policy Comprehensive Essay Example)
The Rationale for Proposed Change
As part of the CMS proposed rulemaking, price transparency seeks to increase consumer access to gross and negotiated rates for services. Price transparency is perceived to make it easier for consumers and make care more affordable because consumers will be more aware of the consequence of various services and products on their spending (CMS, 2021)(Nursing Leadership Health Policy Comprehensive Essay Example). At the end of the Trump era as president, the policymakers proposed that hospitals and insurers offer more health care price transparency as an intervention to reduce health care spending. When consumers know the costs of hospital items and services, they can make informed decisions before receiving them.(Nursing Leadership Health Policy Comprehensive Essay Example)
The intentions of the policy change were good, but the rules have done little to make hospitals bills easier. The cost of hospital care remains high, at $1.2 trillion per year. The high cost has so little financial explanation among the consumers. Medical billing and reimbursement remain complex, increasing the frustration of healthcare providers and patients. The price transparency policy change initiated by the Medicare and Medicaid Services was seen as a victory among health care services consumers (Glied, 2021)(Nursing Leadership Health Policy Comprehensive Essay Example). The initial understanding was that price transparency would accelerate market competition, driving down the health care costs making it affordable for every patient. After implementing the healthcare policy change, price clarity remains elusive, despite considerable investments to comply with the changes.(Nursing Leadership Health Policy Comprehensive Essay Example)
The policy needs more reform to clarify what healthcare providers need to do, including health insurers’ price transparency for all products and services reimbursed and the financial explanations. Consumers need to know what their insurance providers pay at the different health facilities. Price transparency should help patients shop around for the best prices. Most consumers are limited and have minimal knowledge about what their health care plans cover and how much providers reimburse for particular products, services, and procedures (Glied, 2021). The price transparency information is expected to help consumers shop in affordable facilities by understanding how hospitals reimburse for specific guidelines. The new regulations will require healthcare providers to post medical procedures’ prices and clarify unpredictable variables of health care coupled with a confusing web of behind-the-scenes price negotiations between hospitals and insurers that currently make the posted price just a number but not the ultimate price the consumer will pay.(Nursing Leadership Health Policy Comprehensive Essay Example)
Implementation Plan
A recommendation is to demystify and simplify the massive managed care system to reflect consumer-focused price transparency for health care bills. The hospitals and insurers should post the other variables affecting the ultimate cost and the negotiations for the consumers to understand the actual cost of various products and services to make informed decisions(Nursing Leadership Health Policy Comprehensive Essay Example). The policymakers should focus on health services like an emergency, specialty, and complex care that are challenging to anticipate and shop for. Price transparency reforms should ensure the posted information reflects the actual value of products and services to help consumers shop within their means and avoid paying unreasonable prices. The development process will include investigating legislators interested in the policy changes and can offer consistent support. The legislator (s) will receive a written document regarding price transparency reforms. Colleagues will be part of the implementation process, and they will be informed about the opportunities available to influence policy changes. Interested groups and organizations will be invited to lobby on behalf of the nurses and the patients.(Nursing Leadership Health Policy Comprehensive Essay Example)
Legislative Advocates
Reforms to the price transparency policy require legislators and national state nursing organizations. Law and policy changes are effective in reforming and improving health care. The changes will be written to the interested legislators who bring the bill to Congress for debate. The legislators will be responsible for initiating and effecting the policy change to improve price transparency. The national state nursing organizations are crucial to generating considerable energy, idea flow, and proactive work towards policy reforms (Matthews, 2015)(Nursing Leadership Health Policy Comprehensive Essay Example). They will advocate and lobby on behalf of the initiating nurses and patients. The organizations will also monitor the public policy and provide reliable information associated with the policy issues. Organizations such as ANA will represent the views and needs of the nurses and patients in the policy reform process. They will mobilize their members to offer advocacy support. They will also disseminate the professional knowledge required to advocate for the policy changes. The organizations will educate the public to understand the reason behind the policy changes and how they will benefit.(Nursing Leadership Health Policy Comprehensive Essay Example)
Conclusion
The move to ensure price transparency was intended to boost consumer understanding of the billing process and reduce healthcare costs in the process. The understanding was that price transparency would increase market competition because consumers would be more informed about pricing to shop at affordable places. However, the billing process remains elusive as the posted prices do not reflect the ultimate price the consumers will pay for the service or product. Recommendations for reforms include the inclusion of variables used to determine the pricing process and the negotiations between the hospitals and insurance providers to enlighten the consumers about the actual cost of their products and services.(Nursing Leadership Health Policy Comprehensive Essay Example)
References
CMS. (2021, January 12). Hospital price transparency. https://www.cms.gov/hospital-price-transparency
Glied, S. (2021, April 20). Price transparency—promise and peril. JAMA. https://jamanetwork.com/journals/jama/fullarticle/2778818(Nursing Leadership Health Policy Comprehensive Essay Example)
Matthews, J. (2015). Role of professional organizations in advocating for the nursing profession. Online J Issues Nurs, 17(3).
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