Authors: Morgan Muir, JD; Stephanie Alessi; Jaime King, JD, PhD
Other Collaborators: David Faigman, JD, MA (UC Hastings); Clay Johnston, MD, PhD (UCSF); R. Adams Dudley, MD, MBA (UCSF); Thomas Greaney, JD (Saint Louis University, School of Law); Ann Marie Marciarille, JD (University of Missouri-Kansas City, School of Law)
Project Description: At a growth rate of 7 percent, healthcare spending in the U.S. has outpaced GDP growth, threatening the sustainability of the healthcare system. Price transparency is one potential answer to the problem of ever-rising costs in the unique market of healthcare. Currently, confidentiality clauses in provider-insurer contracts make pricing information inaccessible to third parties. Mandating price transparency may serve to spur on competition in certain markets and allow consumers to make more informed choices when selecting health plans and providers. The most effective solutions for implementing a successful price transparency initiative will mandate disclosure of price and quality information at the appropriate stakeholder levels and, simultaneously, break down provider market leverage where it prevents price transparency from helping consumers. This white paper analyzes the impact of several different solutions and recommends four ways to achieve these two outcomes that could reduce healthcare spending and increase quality of care.
Please keep in mind this memorandum is for academic research purposes only and conveys general information about the law. It is not intended to substitute for the advice of an attorney regarding any factual situation.
Go here for more information on our 1/23/2013 event "What Health Care Costs: Bringing Price Transparency to the Medical Marketplace. Speakers from our Grand Rounds, Sam Maizel and Craig Garner, are featured in the December 2012 issue of the Norton Bankruptcy Law Adviser which can be found here.
Centers for Medicare and Medicaid Services has recently released information on Medicare Provider Charge Data, explaining
"The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Year (FY) 2011. These DRGs represent almost 7 million discharges or 60 percent of total Medicare IPPS discharges."