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Health--it's what we all have in common: whether we're trying to maintain our health through good habits or improve our failing health. "Bridges to Health" is 90.5 WESA's health care reporting initiative examining everything from unintended consequences of the Affordable Care Act to transparency in health care costs; from a lack of access to quality care for minority members of our society to confronting the opioid crisis in our region. It's about our individual health and the well-being of our community.Health care coverage on 90.5 WESA is made possible in part by a grant from the Jewish Healthcare Foundation.

New Federal Rule Aimed At Creating Health Care Cost Transparency Might Not Do Much

Jason Redman

Starting January 1, a new federal rule is requiring hospitals to publish online their official charges for different medical services, like diagnostic tests or surgeries.

The Centers for Medicare and Medicaid Services said this policy change will increase cost transparency for patients, especially those, "surprised by out-of-network bills for physicians, such as anesthesiologists and radiologists, who provide services at in-network hospitals, and by facility fees and physician fees for emergency room visits."

But these rule changes are unlikely to help most people, said Carnegie Mellon University health care economist Martin Gaynor. In-network consumers rarely pay the whole list price for a service beccause health insurers pick up a portion of the cost after negotiating service prices with hospitals. Due to those behind-closed-doors negotiations, patients have a hard time predicting their care costs or shopping around for the best deal.

“[List price] information could actually be misleading,” said Gaynor. “In that sense, we could be moving in the wrong direction.”

That’s because hospitals with high list prices might also negotiate very reasonable bills with insurers, and hospitals with low list prices might still charge patients and their insurance for the full amount of a service.

“What CMS is having the hospitals make public is not going to tell people very much about how much things are really going to cost,” said Gaynor. “And it certainly won’t tell people much of anything about how much they might be on the hook for.”

Gaynor says what would really benefit patients are competitive health care markets, where people can easily choose from multiple service providers.

Sarah Boden covers health and science for 90.5 WESA. Before coming to Pittsburgh in November 2017, she was a reporter for Iowa Public Radio. As a contributor to the NPR-Kaiser Health News Member Station Reporting Project on Health Care in the States, Sarah's print and audio reporting frequently appears on NPR and KFF Health News.