Cynthia Fisher on rising prices for hospitals and insurance companies

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When President Donald Trump issued a rule requiring hospitals and insurance companies to publish their prices online, the Liberals were confused.

Cynthia fisher
Patient advocate

“Wait a second,” they asked.

“Who persuaded this guy to do something good like that?” “

Turns out it was Cynthia Fisher, the founder and president of patientrightsadvocate.org.

Its mission: to force healthcare providers and insurance companies to publish their prices online.

Fisher met President Trump on – you guessed it – a golf course in New Jersey and told him about his favorite cause.

She had standing with the president.

Fisher, married to Jim Koch, co-founder of Samuel Adams maker Boston Beer Co., was a major donor to the Republican candidates – giving them $ 1 million in the 2018 cycle.

“We founded patientrightsadvocate.org to make sure we stop the highway robbery in health care, ”said Fisher Corporate Crime Reporter in an interview last week. “Every day, patients do not see the prices that will be charged to them by the industrial health complex. They were taken aback by outrageous overbilling and price increases. Even before they get sick, they agree to pay whatever they are billed for. ”

“The Affordable Care Act gave patients the right to know about all standard health care costs before receiving care. President Trump implemented it by executive order. This ordinance required hospitals, as of January of this year, to post their prices with every health plan and insurer, all displayed in advance and online as well as all discounted spot prices. “

“And starting next year, health insurance companies will be required to post all prices, negotiated rates online in advance, as well as provide the actual prices they are paying – their data from. health claim. ”

“It will be a huge victory for American consumers when this data is released system-wide. It will reduce the costs of our choices and help make health care affordable and accessible to all Americans. “

One of the journalists who has been at the forefront of reporting on surprise medical bills was Sarah Kliff at the New York Times. Have you been in contact with her?

“Yes. We’ve been in contact with Sarah Kliff. And we’ve been in contact with the people she’s written about, people who’ve been ripped off and overcharged. And we’ve taken some of their bills and helped them with their bills. cases and showed how hospitals sometimes wrongly bill some of the people she wrote about. ”

“There are honest doctors who have left this horrible capitalist system of greed that has been overwhelmed by the entire industrial health complex. ”

“Over the past two decades, the pharmaceutical industry, pharmacy benefit managers, health insurance industry, hospitals have come together to maximize revenue and capitalize on patient misfortune by billing and coding up. at the maximum level of income and profit. And this has been a great misfortune for consumers.

“Now we have seen reports showing that 64% of people in the United States are sitting on the sidelines and not getting the health care they need for fear of financial ruin. “

“And we know that ninety percent of Americans want to know – how much is it going to cost? They want this transparency.

“Companies are now pushing employees to go to places that offer the best quality and the best prices. As a result, they give bonuses to employees and increase their wages. They have improved health care by making it much more affordable and accessible. ”

“There are now surgical centers at the forefront of this movement of transparency: the Texas Free Market Surgery Center, the Surgery Center of Oklahoma, the OSS Surgical Center in York, Pennsylvania. Employers send their employees, pay for their travel and the travel of a loved one to these centers, and they always save money.

“They’ve been able to save tens of thousands of dollars on knee replacement surgery. They were paying $ 16,500, including rehabilitation, instead of $ 65,000 or $ 75,000 in an opaque hospital system that upcodes to the max.

“We brought these companies and patients into the last administration to share how they were changing things for the better. No matter where we go as a country, even Medicare for All, it will be a step by step approach to get there. Pulling the curtain down to see these prices is the basis for getting quality care at the lowest possible price. People need to know where to go.

“We’re saying we can save $ 1 trillion out of the $ 4 trillion we spend on health care each year.

“There was an article in the Journal of the American Medical Association that showed that 25% of our health care costs are due to administrative tasks, fraud and errors. And if you don’t know the price to start with, how can you tell if you’ve been fraudulently billed, or overbilled, or billed in error? “

Single payer advocate Kip Sullivan says that in order for a medical good or service to be purchased, four conditions must be met – the need for the service must not be urgent, precise and intelligible, price information ( and ideally the quality) must be readily available, multiple providers of the good or service must exist in the patient’s market, and the cost of the good or service cannot exceed the patient’s deductible (or what remains of it) .

Let’s go through a few of them. Emergency.

If you are the victim of a bullet, you are not able to shop for an emergency room.

“Correct. But let’s say you slice yourself an apple and need stitches. The good thing about having transparency in health care is that it helps pull the curtain down to know whether that emergency room or emergency care visit is competitive. ”

“There is an emergency care center here – the Brigham and Women’s Hospital Urgent Care – I would know right away that they were going to charge me a $ 200 setup fee compared to an emergency care facility. which does not charge me an installation fee. Some of these hospitals charge additional codes which cost consumers much more. I could avoid being charged these fees if I knew where to go.

“It is also in the process of normalizing itself. Look what he is doing in the tech economy by making cell phones affordable for so many people. And this is in part due to competitive prices.

“But I agree if you are in an urgent situation now is not the time to go shopping.”

Kip Sullivan says second, the information must be accurate, understandable and readily available. He says the information available today is often neither accurate nor intelligible. According to him, the few hospital transparency websites he has visited are loaded with jargon, and comparing one jargon-filled website to another will drive you crazy.

“We released a report on hospital compliance six months after the rule came into effect. As of January 1, 2021, hospitals were required to post their prices online, in advance and clearly by all payers and plans. We found that only 5.6% of the 500 randomized hospitals representing each state in this country comply with this law.

“And often there was a clouding of how that information was presented. The good news is that there are comparable technologies like Turquoise Health, FireLight Health, and many more that are starting to create breakthroughs for benchmarking.

“The good news is that the Biden administration has increased fines. A big part of that is the app. To date, the HHS has sent hundreds of letters to non-compliant hospitals. Obviously, thousands of hospitals are not in compliance. We haven’t heard of any enforcement yet, however, the Biden administration just released new rules last week that increased penalties to as much as $ 2 million per hospital. It is not enough, but it is a start.

Are there any penal provisions?

“Not yet. I think a hospital license should be questioned if they are not transparent to their customers about their prices.”

Is there a website where you can compare prices for hospitals in your area?

“Not yet. But there is an example in the pharmaceutical field. It’s called GoodRx. You can go to this website and compare drug prices. This type of app is just around the corner for prices. hospitals Search engines like Google or Yahoo or mobile applications should be online next year with this data for hospitals.

[For the complete Interview with Cynthia Fisher, see 35 Corporate Crime Reporter 45 (11), Monday November 22, 2021, print edition only.]


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