On July 11, the Senate Special Committee on Aging held a hearing to discuss critical issues surrounding health care transparency and the rising costs of care. The American Hospital Association (AHA) provided a detailed statement highlighting the significant factors driving up costs for hospitals and health systems, emphasizing the roles of commercial insurer practices and prescription drug prices.
The AHA underscored the need for additional oversight on Medicare Advantage plans, particularly focusing on the tactics employed by these insurers that restrict and delay patient access to care. These practices contribute to inefficiencies and increased costs within the health care system.
Another major cost driver identified by the AHA is the high price of prescription drugs, which places a substantial financial burden on hospitals and health systems. The organization urged Congress to consider regulatory and legislative measures to address this issue.
The AHA called for improvements in prior authorization processes, which are often cited as a significant barrier to timely patient care. Streamlining these processes could help reduce delays and associated costs.
The AHA expressed concerns about recent legislative moves to no longer recognize price estimator tools as a valid method to fulfill the shoppable services requirement under the Hospital Price Transparency Rule. The organization emphasized that any statutory changes to this rule should take into account the regular adjustments made by the Centers for Medicare & Medicaid Services (CMS).
The AHA noted that CMS has made several recent changes aimed at enhancing transparency and standardization, including:
Standardization and New Data Elements: Efforts to standardize data elements and introduce new ones to improve clarity and usability.
File Accessibility: Enhancements to ensure that pricing files are more accessible to the public.
Accuracy and Completeness Affirmation: Requirements for hospitals to affirm the accuracy and completeness of their pricing information.
Monitoring and Enforcement: Changes to CMS’s processes for monitoring and enforcing compliance with transparency requirements.
The AHA’s statement to the Senate Special Committee on Aging is a call to action for Congress to implement both legislative and regulatory solutions that can help mitigate the rising costs of health care. The organization’s focus on transparency, oversight, and process improvements underscores the need for a comprehensive approach to address the financial challenges facing hospitals and health systems.
As the Senate committee continues to explore these issues, the AHA’s insights and recommendations will be crucial in shaping policies that aim to enhance health care transparency and reduce costs, ultimately benefiting patients and health care providers alike.
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