Administration offers consumers an unprecedented look at hospital charges
May 8, 2013 hhs.gov
Today, as part of the Obama administration’s work to make our health care system more affordable and accountable, Health and Human Services (HHS) Secretary Kathleen Sebelius announced a three-part initiative that for the first time gives consumers information on what hospitals charge. New data released today show significant variation across the country and within communities in what hospitals charge for common inpatient services. Also today, HHS made approximately $87 million available to states to enhance their rate review programs and further health care pricing transparency. In an example of how these data might be used, the Robert Wood Johnson Foundation (RWJF) is planning a data visualization challenge which will further the dissemination of these data to larger audiences.
“Currently, consumers don’t know what a hospital is charging them or their insurance company for a given procedure, like a knee replacement, or how much of a price difference there is at different hospitals, even within the same city,” Secretary Sebelius said. “This data and new data centers will help fill that gap.”
The data posted today on CMS’s website include information comparing the charges for services that may be provided during the 100 most common Medicare inpatient stays. Hospitals determine what they will charge for items and services provided to patients and these “charges” are the amount the hospital generally bills for an item or service.
“Transformation of the health care delivery system cannot occur without greater price transparency,” said Risa Lavizzo-Mourey, M.D., RWJF president and CEO. “While more work lies ahead, the release of these hospital price data will allow us to shine a light on the often vast variations in hospital charges.” These amounts can vary widely. For example, average inpatient charges for services a hospital may provide in connection with a joint replacement range from a low of $5,300 at a hospital in Ada, Okla., to a high of $223,000 at a hospital in Monterey Park, Calif.
Even within the same geographic area, hospital charges for similar services can vary significantly. For example, average inpatient hospital charges for services that may be provided to treat heart failure range from a low of $21,000 to a high of $46,000 in Denver, Colo., and from a low of $9,000 to a high of $51,000 in Jackson, Miss.
To make these data useful to consumers, HHS is also providing funding to data centers to collect, analyze, and publish health pricing and medical claims reimbursement data. The data centers’ work helps consumers better understand the comparative price of procedures in a given region or for a specific health insurer or service setting. Businesses and consumers alike can use these data to drive decision-making and reward cost-effective provision of care.
The Affordable Care Act also makes available many tools to help ensure consumers, Medicare, and other payers get the best value for their health care dollar. Medicare is beginning to pay providers based on the quality they provide rather than just the quantity of services they furnish by implementing new programs such as value-based purchasing and readmissions reductions. HHS awarded $170 million to states to enhance their rate review programs, and since the passage of the Affordable Care Act, the proportion of insurance company requests for double-digit rate increases fell from 75 percent in 2010 to 14 percent so far in 2013.
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“ Because of the Affordable Care Act, insurers now have to justify double-digit rate increases publicly, for everybody to see. And most states have new authority thanks to incentives under this law to reject unjustifiable rate increases. Insurers are now required to spend at least 80 percent of the money you pay in premiums on actual health care -– not on profits, not on overhead, but on you. And if they fail to meet that target, they actually have to reimburse you — either with a rebate or lower premiums. Millions of Americans discovered this last year — they opened an envelope from their insurance company that wasn’t a bill, it was a check. That’s already happened. A lot of people don’t know it, but that’s what the Affordable Care Act is all about.
Beginning this week, as part of the law’s price transparency tools, we made public the prices that different hospitals charge you for most common services, so you can see if you’re getting what you pay for. And soon, bad actors in the insurance industry will never again be able to discriminate against you just because you’ve gotten sick in the past. They can’t discriminate against you because you’ve got a preexisting condition. And, by the way, they can’t charge you more just for being a woman. Pregnancy will no longer be considered a preexisting condition.
And finally, beginning this fall, if you’re one of the millions of Americans who don’t have health insurance, you’ll finally have the chance to buy quality, affordable care just like everybody else.
So here’s how this is going to work. We’re setting up a new online marketplace where, beginning October 1st, you can go online, or talk to organizations in every state that are going to have this set up, and you can then comparison shop an array of private health insurance plans. You can look at them side-by-side, just like you’d go online and compare cars. And because you’ll now be part of a new pool of millions of other Americans, part of this exchange, insurance companies will actually want to compete for your business the same way they compete for the business of a big company with a lot of employees.
So once these marketplaces are up and running, no one can be turned away from private insurance plans. Period. If you’re sick, you’ll finally have the same chance to buy quality, affordable health care as everybody else. If you can’t afford to buy private insurance, if it’s still too expensive — even though you’re getting much better prices through these exchanges than you would in the individual market, going out there by yourself, or if you work for just a small company that doesn’t have a lot of leverage with insurance companies you’re going to have a better deal through these exchanges — but if you still can’t afford it, then you’re going to get help reducing your out-of-pocket premiums with the largest health care tax cut for working families and small businesses in our history.
So what does all this mean? It means that if you lose your job, or you change your job, or you start that new business, you’ll still be able to purchase quality, affordable care that’s yours — and you’ll have the security and peace of mind that comes with it. If you’re a young person expecting to try many different jobs and careers until you find one that suits you, you’ll be able to buy insurance that goes with you, travels with you, that gives you the freedom to pursue whatever you want without the fear that illness or accident somehow derails your dreams.
So there’s a lot that this law is already doing for Americans with insurance, and there is a lot more that is going to happen for folks who don’t have insurance. But we’ve still got a lot of work to do in the coming months to make sure more Americans can buy affordable coverage. “
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Peace Officers Memorial Day and Police Week is an observance in the United States that pays tribute to the local, state, and Federal peace officers. The Memorial takes place on May 15, and Police Week is the calendar week in which the Memorial falls.
“Day after day, police officers in every corner of America suit up, put on the badge, and carry out their sworn duty to protect and serve. They step out the door every morning without considering bravery or heroics. They stay focused on meeting their responsibilities. They concentrate on keeping their neighborhoods safe and doing right by their fellow officers. And with quiet courage, they help fulfill the demanding yet vital task of shielding our people from harm. It is work that deserves our deepest respect — because when darkness and danger would threaten the peace, our police officers are there to step in, ready to lay down their lives to protect our own.
This week, we pay solemn tribute to men and women who did. Setting aside fear and doubt, these officers made the ultimate sacrifice to preserve the rule of law and the communities they loved. They heard the call to serve and answered it; braved the line of fire; charged toward the danger. Our hearts are heavy with their loss, and on Peace Officers Memorial Day, our Nation comes together to reflect on the legacy they left us.
As we mark this occasion, let us remember that we can do no greater service to those who perished than by upholding what they fought to protect. That means doing everything we can to make our communities safer. It means putting cops back on the beat and supporting them with the tools and training they need. It means getting weapons of war off our streets and keeping guns out of the hands of criminals — common-sense measures that would reduce gun violence and help officers do their job safely and effectively.”
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