Political campaigns for elected office can be exhaustive affairs for voters, particularly when they occur in months and even more than one year in advance of an election. A more optimistic view of the matter suggests, however, that these contests are enormously valuable in shedding light on the nature of important social issues and how best to address them.

Health care represents close to 20% of the U.S. economy, the largest in the world. Even when healthy, individuals want to know they are protected to a great extent from the ravages of illness and disease by being able to have insurance coverage. In its simplest form, they want to derive comfort from knowing that cost will not inhibit them from obtaining the care that they need when they need it from the providers they wish to furnish treatment.

Presently, several candidates are competing to determine which one will secure the nomination for the presidency in 2020. Rightfully so, they focus much of their potential electability in the eyes of voters on how they plan to address health care issues in this country. Proponents of a Medicare For All initiative promise to offer an extensive range of benefits by the government at no cost to patients. Their appeals differ on the basis of details, such as the time needed to implement the new program and how to pay for it. Other candidates stress the need to maintain a system of private insurance coverage.

As debates continue to unfold, policy analysts who support as well as those who oppose such proposals weigh in with their respective critiques of what is being touted as an overhaul of a a remarkably complex system. An advantage of their doing so is that a clearer picture emerges of whether ideas currently being proposed will represent either an improved or perhaps even a worse future arrangement.

Hospital Compare Data On Quality

November 4, 2019 began a 30-day preview period for hospitals to see the data that will be reported publicly on Hospital Compare next year. As part of the Inpatient Psychiatric Facility Quality Reporting (IPFQR), Hospital Inpatient Quality Reporting (IQR), Hospital Outpatient Quality Reporting (OQR), and Prospective Payment System (PPS)-Exempt Cancer Hospitals Quality Reporting (PCHQR) programs, hospitals have 30 days to preview their data prior to public reporting on Hospital Compare. As part of this preview, hospitals (excluding cancer hospitals) also will see an updated Overall Hospital Quality Star Rating that publicly will be reported on Hospital Compare next year.

Hospital Price Disclosure Rule

On November 15, 2019, the Centers for Medicare & Medicaid Services (CMS) finalized policies that follow directives in President Trump’s Executive Order, entitled “Improving Price and Quality Transparency in American Healthcare to Put Patients First,” that lay the foundation for a patient-driven healthcare system by making prices for items and services provided by all hospitals in the United States more transparent for patients so that they can be more informed about what they might pay for hospital items and services.

CMS is finalizing the proposal to define hospital “items and services” to mean all items and services, including individual items and services and service packages, that could be provided by a hospital to a patient in connection with an inpatient admission or an outpatient department visit for which the hospital has established a standard charge. Examples of these items and services would be supplies, procedures, room and board, use of the facility and other items (generally described as facilities fees), services of employed physicians and non-physician practitioners (generally reflected as professional charges), and any other items or services for which a hospital has established a standard charge.

It is highly likely that the hospital industry will mount a legal challenge to the imposition of this rule. At issue is a requirement that hospitals make public the rates they negotiate with insurers for all services.

return to november 2019 trends

HEALTH REFORM DEVELOPMENTS

Hospital Compare Data On Quality

Hospital Price Disclosure Rule

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