Price Caps for ED and Out-of-Network Care: The Next Step to Reign in Hospital Costs?

Regulation is needed to institute price caps on emergency and out-of-network care in hospitals, according to an op-ed written by Robert Murray and published on Health Affairs' blog site.

Acknowledging most hospitals rarely receive payments at the price-levels listed in their chargemaster, Mr. Murray argued hospitals' "sticker prices" still influence the cost and price of care.

"High and increasing hospital charges, combined with increasing proportions of cases admitted through the hospital emergency department, are major factors behind the ever-declining negotiating leverage of private health insurers. This situation, coupled with the increased pricing power of the ever-more-concentrated provider industry, will be a major contributor to the almost certain rapid escalation in total U.S. healthcare costs in coming years," Mr. Murray wrote.

Flat-fee Medicare Advantage plans are somewhat shielded from hospitals' "predatory" ED billing practices, he concludes, and similar protections should be extended for out-of-network medical procedures. Doing so would empower private payors to exert more downward pressure on rising hospital prices.

More Articles on Hospital Prices:

The Most Expensive Hospital in America
AHA President: What Hospitals Charge Rarely Reflects What They Are Paid
Hospital Price Index Sees Biggest 1-Month Drop Since 2004

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