The Transparency in Coverage Rule (TiC) went into effect in July of 2022. One of the key requirements is that hospitals must publish prices for 300 common services. In our last article we discussed some of the main obstacles facing the Transparency in Coverage Rule. Today we will judge progress for ourselves by getting a price on a medical service. Can we get a price? Is it that easy?
In short, both hospitals and insurers are not complying with the rule. When “rules” are ignored, it is often because there is no enforcement. That may be the case here as well. The rule took effect on July 1, 2022, however, only 14% of hospitals were in compliance a year later. According to a report by CMS, as of 2022, there have been no fines, and even if there were fines, they would be mere chump change to most hospitals and insurers.
Rules, rules, rules…wearing seatbelts, smoking in public, speeding, etc. Even these rules took time to gain traction when they were implemented. In the 1980’s only about 10% of Americans wore their seatbelt! New York passed the first seatbelt law in 1984. Since that time, laws and enforcement have gotten us up into the mid-90’s percentage-wise.
So how did we get from 10% seatbelt use in the 1980’s to well over 90% today?
Enforcement has a lot to do with it. Enforcement of seatbelts is straight-forward, there are police ready, willing and able to catch you breaking the rule and write you a ticket. And there is money to made – FINES. You speed, you get fined.
Is there a hospital police? No, not really, and if there was, pushback on enforcement would be fierce from hospital special interests whom would decry compliance as burdensome and costly. So, until some three-letter government agency starts aggressively handing out stiff fines, nothing will happen.
Just like with speeding, there needs to be enforcement that is ready, willing and able to catch hospitals and insurers breaking the rule, and write them costly “tickets”. Again however, according CMS, nothing has been done on enforcement.
Are you catching on?
Let’s see for ourselves. Let’s visit my local hospital in where I live in Florida and try and get a price on a CPT code 31233 (nasal/sinus endoscopy). First, we visit the main website. Nope, nothing on the main site about pricing. But they are rebranding, which will definitely improve Quality, Access and Affordability.
Next, I tried the search bar. Viola. Something about pricing. So far so good. NCH seems to be one of the good hospitals that is trying to be transparent with their pricing. I can even get a price on a Bamboo Teddy Bear in the gift shop. Hopefully getting the price for the nasal/sinus endoscopy is also this easy!
Once I arrive the at main pricing page, I find the esteemed price list that is supposed to be accessible to everyday people like me, as per the TiC rule.
Once we click on the link for the HTML “viewable” file, we find it is anything but. The webpage is so large that I cannot load it on my computer.
Anyone with basic web development skills knows that a page this large is useless. It will not load. Especially on a mobile device, which accounts for most traffic these days. Maybe it was my laptop? I doubt it. I rarely, if ever, encounter this problem.
But credit where credit is due and kudos to my local hospital for being one of the 14% that is making the effort. And I 100% mean that. They are taking the first steps in the right direction. Sure, there are few glitches to work out, buy hey, they are one of the few that is making the effort and for that I applaud them. Rome wasn’t built in a day.
They do however need to make the page easier to find and they need to make the data accessible on common devices. Perhaps a pricing link on the home page or footer or main navigation. To make the page loadable they could invest in building a few more pages to break up the data. Perhaps they could break it down by specialty or even a searchable dynamic data set.
In short, the TiC will not effectively reduce healthcare costs because no one is enforcing the rule. They will pull you over for speeding in heartbeat, but if you want the price on a nasal/sinus endoscopy, good luck!