Stacks of pills and coins TheAssociation of Health Insurance Providers warns that disclosure ofnegotiated prices wouldde-incentivize insurers to offer lower,more-competitive bids, thus driving up prices. (Photo:Shutterstock)

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In a move hailed as a major win for health care pricetransparency, the Centers for Medicare and Medicaid announced lastyear that as of January 1, 2021, hospitals would be required to post negotiated rates for commonmedical procedures.

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Many in the health industry worry the rule would cause more harmthan good, and just add to the current confusion surrounding ourcomplex health care billing system.

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Related: How will the CMS's new health care pricetransparency rule play out?

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"Forced disclosure of privately and competitively negotiatedrates, as proposed in this rule, will not provide information thatis actionable by, or helpful to, consumers and exceeds thedepartments' statutory authority," insurer lobbying group America'sHealth Insurance Plans said in a written comment to the CMS.

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Instead, AHIP argues, the disclosure of negotiated prices wouldthrow a wrench in the health insurance market and de-incentivizecompanies to offer lower, more-competitive bids, which would inturn drive up prices. On top of that, it's a violation oftheir Constitutional rights.

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Also voicing their concerns with the rule were the Alliance ofCommunity Health Plans, Association for Community Affiliated Plans,American Hospital Association, Business Group on Health andAmerican Benefits Council.

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"The council is deeply concerned that even with good faithefforts, plans may be unable to obtain some of the informationneeded to complete the required disclosures," ABC wrote. "Thecouncil strongly urges that final regulations include a safe harborto address this issue."

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Aside from concerns over being forced to divulge trade secrets,the groups were concerned with the administrative burden the newlaw will place on insurers and employers, the potential focus onfee-for-service versus value-based care, potential patient dataprivacy issues, and the confusion it would cause among consumerswho don't understand the context of the prices.

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"The proposed rule would require health plans to provideinformation on all covered items and services. No existingtransparency technology solution we are aware of supports thislevel of information — nor would they want to, since much of therequired information could confuse and mislead consumers and thecosts to implement would be enormous," the Blue Cross and BlueShield Association wrote.

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BCBSA cited an analysis from Bates White that peggedthe cost of compliance for an insurer at $13.6 million, much higherthan the $510,000 estimated by the CMS.

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"We have long supported efforts to make quality and pricinginformation more accessible, understandable and actionable forconsumers. But they need real-time, patient-specific informationtied to individual coverage benefits — not a massive published listof prices that may only frustrate consumers and likely increasecosts over time," wrote the Alliance of Community Health Plans.

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Still, while they disagree with the CMS's transparency rule,many in the health industry voiced their support for findingsolutions to improve the patient experience.

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"We fully support the goal of empowering Americans with easilyaccessible cost and quality information to make more informeddecisions," AHIP president and CEO Matt Eyles said. "AHIP stronglyurges the Departments to adopt workable solutions that ensurehealth care information is personalized, easy to understand,accurate, and actionable, focusing on health care treatments andservices for which consumers can actually shop."

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Emily Payne

Emily Payne is director, content analytics for ALM's Business & Finance Markets and former managing editor for BenefitsPRO. A Wisconsin native, she has spent the past decade writing and editing for various athletic and fitness publications. She holds an English degree and Business certificate from the University of Wisconsin.