A Trump-era rule that went into effect January 1, 2021 requires healthcare providers to publish their prices online. According to an NPR report from July of that same year, compliance was a mixed bag. Some providers had only published prices on select services while others had not published anything at all. Is it time to move from publishing data to forced reporting?
Requiring healthcare providers to publish prices is designed to reduce costs by leveraging transparency to encourage competition. As the thinking goes, price transparency will encourage patients to shop around for the best possible price on a range of services and procedures. But if healthcare providers are not fully complying, we may never know whether it works.
Reporting prices to government agencies could be a way around lackluster compliance. Utah just enacted a reporting program for providers offering cannabis-related services in the state. Failure to report, or reporting inaccurate prices, subjects a provider to penalties.
Publishing vs. Reporting
The question is whether the differences between publishing and reporting are meaningful enough to affect the desired outcome, which is greater transparency and competition. In a publishing scenario, healthcare providers are expected to publish pricing data on their websites. But how they go about it is their business.
NPR reported in 2021 that some providers are burying the information so deeply in their website that it is nearly impossible to find. The information is still publicly available, but the patients often have to dig around. Most will not bother.
Another weakness of the publishing scenario is that enforcement – if it occurs at all – requires someone in a state or federal agency scouring websites to verify compliance. It is a safe bet that doesn’t happen. Utah’s reporting program works around that issue.
An Online Database
According to the owners of the Deseret Wellness medical cannabis pharmacy in Provo, Utah qualified medical providers (QMPs) marketing cannabis-related services in print or online must report their prices to the state. The state then publishes that information on a dedicated website.
Here is the thing: the state already maintains a database of all licensed QMPs. A medical provider will not bother becoming a QMP if there are no plans to market their cannabis services so, by default, the state already has a complete list of healthcare providers required to report their fees. This makes it relatively easy to automate discovery of noncompliance.
Rather than having to search endless websites, enforcement officials need only investigate providers whose online accounts are red flagged due to database conflicts. Enforcement becomes much more efficient because regulators don’t have to go looking for data. The data is provided automatically.
Reporting on a Federal Level
Requiring similar reporting at the federal level could prove more effective than the current system. Yet that does not make the idea a good one. Creating and maintaining an automated federal database would be a gargantuan task that would cost millions to implement. Even then, the system would have to be continually maintained.
Can a federal government barely able to administer Social Security be trusted to handle something so encompassing? Probably not. The fact is that bureaucracy breaks things. Mandated reporting may work on a state-by-state basis, but it is probably not doable at the federal level.
That means we are left with the current system. It’s better than nothing at all. Hopefully, healthcare providers and health insurance companies (they were added to the mix in 2022) will comply without having to be compelled. Their willingness to embrace transparency will make healthcare better for everyone. Now let us see how many of them get on board.