Importance of Price Transparency for Patients

"Focusing on price transparency in healthcare is a waste of time." That’s what a colleague recently told me in the middle of a spirited debate about healthcare costs —someone who’s worked in this space for years. His stance was clear: it’s a waste of time and resources to try and bring about price transparency because the data is too complex, too messy, and “no one is ever actually going to use it.” He’s not alone. I’ve heard that line echoed by skeptics across the industry—many of whom, ironically, either profit quite handsomely from the opacity they claim is too hard to fix or monetize the transparency data they claim is unusable for everyone else. I have a suggestion. We should stop framing this as a question of whether patients can “shop” for care. That language can be reductive, dehumanizing and offensive. My body, my child’s emergency surgery, a loved one’s cancer treatment—these are not commodities. It’s painfully ironic that my colleague, claiming to represent the position of most hospitals, continues to talk about people as “throughput," "market share" and “heads in beds.” This might be an unpopular opinion, but I believe the goal of transparency is not to turn patients into price hunters. It’s to give people—patients, families, employers, purchasers—the ability to understand what they’re paying for, how much it costs, and what their options are before they receive care. It’s to prevent the gut-punch of a surprise bill. To allow a plan sponsor to detect wildly inflated charges. To drive better decisions about network design, site-of-service redirection, benefit incentives, and accountability. Will every patient parse a machine-readable file? Of course not. But that doesn’t mean the data is useless. It means it needs to be translated, integrated, and applied.  We’ve taken messy, complex systems—air travel, mortgages, international finance—and built tools that help people make informed decisions. Not because every consumer becomes an expert, but because access to information was made usable. We must imagine a future that is not constrained by the limitations of today. And we should start by changing our language. I don’t know who first started using the term “shopping for healthcare.” It probably came from a well-intentioned place—a way to convey that patients should have choices, and that price should be one of them. But it’s overly simplistic. It can be patronizing. And it fails to reflect the gravity of what people are actually navigating. We don’t say we’re “shopping” for colleges when we tour campuses or “shopping” for legal advice, mortgage terms, or childcare providers. We educate ourselves, we seek clarity, we make informed decisions. That’s what we should be striving for in health care—not shopping, but understanding. It’s time to retire the retail analogy and upgrade our expectations. People don’t need to be better shoppers. They need to be better informed.

Imagine walking into a restaurant where there are no prices on the menu. You order a steak, enjoy your meal, and only weeks later receive a bill, $35 if you were lucky, $350 if you weren’t. That’s how healthcare pricing works in America. Price discovery isn’t just a luxury, it’s the foundation of a functioning market. For consumers, it means knowing what you’ll pay before getting care, rather than being blindsided by opaque billing games. For employers, it’s the difference between controlling benefit expenses and writing blank checks to insurers and hospitals. And for governments, price discovery is what prevents waste, fraud, and the steady erosion of budgets driven by misaligned incentives. Right now, we have a system where a routine MRI can cost $400 at one facility and $4,000 at another, often within the same zip code. That’s not competition; that’s chaos. Markets only work when buyers and sellers both have access to prices. Until we demand price discovery in healthcare, the system will remain rigged, designed to protect middlemen while patients, businesses, and taxpayers foot the bill. It’s time to stop playing this game blindfolded. Transparency isn’t just about seeing the numbers, it’s about shifting power back to those who actually pay for care. #healthcare

Price Transparency Drives Better Decisions in Healthcare — and JFK Just Showed Us Why This weekend, I landed at JFK with my family. Like most travelers, I had a choice: Yellow Cab 🚕 or Uber/Lyft 🚗. For a while, both were competitive because ride-share cars were just as convenient, sitting right outside baggage claim. But recently, JFK changed the rules. Uber and Lyft now require you to take a shuttle, adding time and hassle. Tired, with three kids in tow 👨👩👧👦, I chose convenience and grabbed a Yellow Cab. The problem? The driver couldn’t tell me the price of my ride home. I later found out it cost me 10% more 💸 than the transparent fare I would’ve seen on Uber or Lyft. By changing the rules, JFK biased my decision-making. And it’s the same thing we see happening in healthcare 🏥 every day. In healthcare, lack of price transparency leaves patients without a clear idea of cost or value. Just like my cab ride, people often default to what’s most convenient—whether it’s a provider, a treatment, or a location—because the alternatives are harder to navigate. They don’t know the price up front and are left hoping the choice works out in their favor. But here’s the thing: transparency doesn’t just save money 💡. It drives competition, improves quality, and helps patients make informed decisions that align with their needs. At JFK, I paid the price for biased rules. In healthcare, patients shouldn’t have to. What are your thoughts? 🗣️ How can we make price transparency the norm and create a system where decisions are based on real value? #HealthcareLeadership #PriceTransparency #ValueBasedCare #HealthcareInnovation 🚀

Rapper Fat Joe is making waves beyond the music scene by championing healthcare price transparency. Teaming up with the nonprofit Power to the Patients, he's advocating for hospitals and insurers to disclose actual prices for services and procedures. Fat Joe emphasizes that hidden costs in healthcare lead to overcharges and financial hardship for countless Americans. He asserts, "Our very own healthcare system is robbing all of us." Beyond the Public Service Announcements, Fat Joe has actively lobbied lawmakers on Capitol Hill, urging them to enforce and strengthen legislation mandating price transparency in healthcare. His efforts aim to empower patients with the information needed to make informed decisions and foster competition among providers, ultimately driving down the costs. It's inspiring to see influential figures like Fat Joe use their platforms to advocate for system change that benefits all Americans.

CMS fined 14 hospitals over $5 million for hiding prices in 2024. WHY? Because they refuse to post machine-readable pricing files. Because they bury the data behind broken links and unusable formats. Because they know what happens when people can actually compare. Patients are not idiots, but the system is treating them like one. We all know this, and it should be said out loud: → A colonoscopy shouldn’t cost $15,000 at Hospital A and $3,200 at Hospital B → The same MRI shouldn’t be billed at $350 in a clinic and $2,800 in a system, for the same patient, same doctor, same machine. They still do it because pricing secrecy is their biggest weapon. Price transparency is nowhere to be found because they know: – Every time a patient sees the price, they ask questions. – Every time an employer sees the markup, they push back. – Every time a physician sees the loophole, they choose independence. The system wants to control everything and maintain that power. So, they are doing everything to keep patients & physicians scared of the system. Only independent practices can use transparency as leverage now. And they need to come ahead with: • Direct-pay clinics • Transparent imaging centers • Price-posting surgery groups • Shared ownership RCM models Fighting back isn’t an option anymore. It’s a necessity! How do you think we can make price transparency normal in healthcare? PS – What is a price that shocked you the most in your entire healthcare journey? #pricetransparency #physicianautonomy #cms #patientcare

Skeptics of the usefulness of a medical bill search engine have told me countless times: "People with health insurance don't care about prices since insurance takes care of the bills." That may have been true in 2018, when patients with insurance accounted for just 11.1% of hospitals' bad debt. By 2022, that number went up to 57.6%. People with health insurance now account for the majority of medical debt to hospitals. Centers for Medicare & Medicaid Services recently enacted changes to its Hospital Price Transparency Rule from 2021, with many new rules going into effect in July 2024. With more than 100 million Americans having medical debt of some kind, price transparency in healthcare will become more and more important not only to the industry players but also all patients seeking care in the US--both insured and uninsured. (Article: https://lnkd.in/gU5NZETX)