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Navigating Healthcare’s Price Transparency Maze: Are Hospitals Following the Rules?

A core principle of a functioning market is transparency, allowing consumers to make informed decisions based on accurate information. This principle extends to healthcare. Since 2021, the Centers for Medicare and Medicaid Services (CMS) has mandated price transparency, requiring hospitals to disclose costs for at least 300 commonly performed services. Yet, whether this policy is achieving its intended impact remains intensely debated.

A recent report by the nonprofit Patient Rights Advocate claimed a sobering statistic: only 33% of North Carolina hospitals are in compliance with the price transparency rule. This finding starkly contrasts with CMS’s recognition of 63% national compliance based on their audit.

Adding fuel to the fire, Patient Rights Advocate’s list of noncompliant hospitals eclipses the hospitals CMS has directly penalized. "The Centers for Medicare and Medicaid Services (CMS), in their November 22, 2023, OPPS Final Rule, confirmed that only CMS can make a determination as to a hospital’s compliance with the HPT (hospital price transparency) requirements," an Advocate Health spokesperson questioned the legitimacy of such lists adding to the confusion.

Despite the CMS mandate, navigating the healthcare system remains shrouded in ambiguity, exemplified by NPR’s ‘Bill of the Month’ feature, which highlights the complexity and variations encountered by patients when facing medical bills.

The true cost of a procedure is rarely upfront and clear-cut. Many patients find themselves surprised by bills, piecemeal delivery, and sometimes, charges they feel are unjustified.

“The purpose of the price transparency rule is to force accountability and integrity, to drive down the cost of care and ensure consumers are well-informed and benefitting from competition and choice," stated Cynthia Fisher, Chairman of Patient Rights Advocate. "Healthcare is the only place in our economy where prices are hidden, and bills come in pieces by mail, weeks or months later."

The discrepancy between advertised compliance and the lived experience raises important questions. Are the CMS standards the right ones? Is CMS failing to adequately enforce the rules?

Some argue that current penalties are insufficient to incentivize compliance. "CMS has not been enforcing the law," claims Fisher.

Limited Enforcement and the Illusion of Compliance

The deterrent power of penalties is debated. A minimal number – only 15 hospitals nationwide – have faced robust financial penalties since 2021. One such instance involves Betsy Johnson Hospital in Harnett County, North Carolina.

"We take compliance with these federal regulations seriously, and our teams have been committed to staying up-to-date and in compliance with the various iterations of the CMS Price Transparency Rule," affirmed Michael McAllister, spokesperson for Novant Health, which has faced numerous warnings and corrective action plan requests, highlighting the complex environment.

Yet, the effectiveness of CMS enforcement itself is questioned by some, particularly for hospitals with significant financial resources. "These hospitals are multi-billion dollar enterprises and can stand to pay a small fine," commented incoming North Carolina Treasurer Brad Briner, hinting at the need for stronger deterrents.

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CMS raised the penalty for noncompliance to $2 million. While north Carolina is not immune,

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Too what extent are hospitals currently able to provide⁣ the granular pricing data needed by consumers to make informed choices about⁤ their care, and what are the barriers to achieving this level of transparency?

**Interviewer:** Cynthia Fisher, Chair of Patient Rights Advocate,​ argues that the purpose of the price transparency rule is to drive down the cost of care and ensure consumer choice. Do you believe‌ hospitals are truly equipped‍ to ⁣provide the level ​of detailed pricing data necessary to empower consumers ⁢in this way? What role should CMS play in ensuring meaningful price transparency?

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In late October, I experienced a sudden mishap while riding my bike, resulting in a fall that left me landing painfully on my left elbow and hip on the unforgiving pavement. Just a few days after the incident, I felt compelled to get my aching arm and elbow examined by a professional, knowing that pain should not be ignored.

What surprised me more than the minor fracture discovered in my forearm was the reaction of one of the doctors, who seemed startled that an 80-year-old like me was still actively cycling. His attitude indicated that he disapproved of my choice to ride at this age, leaving me feeling more shaken by his judgment than the injury itself.

As soon as he walked into the examination room, his frown communicated a clear message: “Why on Earth is an 80-year-old on a bike?” I shared with him how I had miscalculated a U-turn at a speed that was too fast, recognizing that I needed to be more cautious as I age.

As he wrapped up the consultation, he advised me that “there are some activities you can do both inside and outside” and that my biking should be confined indoors. Taken aback by his statement, I firmly replied, “I’ll always be outside,” voicing my commitment to embracing the natural world.

Was doctor’s response ageism − or just care for his patient

“I’ve seen some really terrible injuries from bike accidents,” he stated with disapproval, wrapping up his admonishment. While his concern for my safety was evident, I felt dismissed and unheard, which troubled me deeply. After reflecting on the encounter for a day, I sought opinions from fellow cyclists and friends about their thoughts on the interaction.

Their responses were overwhelmingly critical, with words like “Inappropriate,” “Insulting,” and “No place for ageism” floating around. Most felt that the doctor had overreacted to an incident that was relatively minor. One cyclist in her 70s offered a perspective that resonated with me: “Life happens.” She emphasized the inevitability of accidents being part of living fully.

As days passed, I endeavored to grasp the doctor’s perspective better. I wished I had been more assertive in detailing the importance of cycling in my life, hoping to foster a meaningful dialogue with him.

Cycling is more than just a pastime for me; it serves as a vital aspect of my life, contributing to physical fitness, mental wellness, and providing a unique perspective as I traverse through diverse landscapes. Much like swimming, I sincerely hope to keep biking for as long as I can. My history of maintaining an active lifestyle has equipped me to continually weigh the risks against the numerous benefits that biking offers.

The joy of cycling was instilled in me in childhood when riding my bike to school unleashed an exhilarating sense of freedom. During my 40s, I rediscovered that splendid feeling, and it has been a passion that has only grown stronger since.

A cyclist’s creed: I’m happier, healthier, more sociable on my bike

Biking evolved into my preferred outdoor activity, as I surrounded myself with a conscientious group of friends who share this interest. Each weekend spent on the road with them added to my happiness, health, and sociability. I initially learned to navigate roads while cycling in a group through the Charles River Wheelers, a renowned bike club in Greater Boston, and became involved with the Appalachian Mountain Club. My commitment to safety was reinforced by attending a workshop offered by the League of American Bicyclists, who believe that “Life is better for everyone when more people ride bikes.”

In my 50s, I collaborated with a coworker living in Cambridge, and we rode our bikes to work in Quincy, a round-trip journey of approximately 20 miles. Our early morning rides took us along Boston’s scenic Emerald Necklace, winding through Jamaica Plain and Dorchester, culminating with the Blue Hills and Quincy, an experience we cherished immensely.

On weekends and weekday evenings, I became accustomed to riding long distances — anywhere from 40 to 65 miles at a time. As I entered my 60s and 70s, I gradually reduced my mileage, yet still maintain an impressive daily ride of 14 to 25 miles, up to five days a week, mainly during the summer and early fall. Though I’ve mostly shifted my rides from busy roads to serene bike paths, I do venture onto roads for short stretches. My average speed hovers around 10 mph, and I always prioritize safety by wearing a helmet and equipping my bikes with headlights and flashing red tail lights along with cyclometers for tracking my progress.

It wasn’t my first bike accident

Throughout my years on a bike, I’ve encountered several accidents. In Plattsburgh, New York, about 20 years ago, a driver crewed past me before abruptly turning right, veering directly into my path. Though I struck the side of her car and sustained some bruises, I ultimately emerged relatively unscathed. In 2018, I faced a more severe fall when I collided with improperly placed steel plates covering roadwork, which caused me to flip sideways off my bike. The result was major bruising on my hip, but again, I thankfully had no broken bones.

Given my extensive biking history, I wished I had been more vocal during my visit, encouraging open communication with the older doctor who expressed such clear disapproval.

Two days later, I stumbled upon a recent blog post at Hebrew SeniorLife advocating for older adults to take charge of their own healthcare and how to navigate conversations effectively in a doctor’s office.

You need to advocate for what matters the most to you

Geriatrician Dr. Matthew Schuster emphasizes the significance of patients actively advocating for their own well-being. He highlights the necessity of preparing for medical appointments by considering personal health goals and determining what matters most.

The follow-up visit following my fall started on a much brighter note with a younger doctor, who entered the room with a refreshing attitude. She expressed admiration for meeting an “80-year-old still biking,” inviting me to share my experience of the incident.

‘I want to meet the person who is 80 and still rides a bike’

I vividly recounted how I had suddenly gone down. Just moments before, I was cycling along a quiet beach road in Falmouth, taking a scenic detour off of the Shining Sea Bikeway. I admired the beautiful landscape, noting the empty osprey nests and the sun shimmering off Buzzards Bay. But as I began my U-turn, I misjudged the speed, leading to my fall as my foot caught on the pedal.

After ensuring that my hand’s fingers were functioning properly and confirming full mobility in my left arm, I initially felt relieved — “Good, I didn’t break anything,” I thought. I climbed back on my bike, called my friend to cancel our plans to go for a walk, and cycled the five miles back to my car. I felt fine until shortly after the ride when pain and stiffness kicked in, particularly in my left elbow and forearm. Once I returned home, I used ice packs and took anti-inflammatory medication for relief.

When discussing the accident with the initial doctor, I acknowledged the need to exercise caution while biking as I grew older. She accepted my view and promptly scheduled X-rays for both my forearm and elbow. Upon leaving her, the older supervising doctor entered the room and listened to my account.

While most of my peers agreed that the elder doctor overreacted, a couple of individuals understood his protective stance.

What age is too old to ride a bike? That’s the wrong question

My experience led to contemplation about what age is deemed “too old” to engage in biking or other sports. I took the question online to gather wider opinions.

An AI response underscored that “Age 80 is generally not considered too old to ride a bike, as long as the individual is physically capable and takes necessary safety precautions.” It highlighted the role of cycling as a beneficial exercise for seniors, allowing many to enjoy biking into their 80s.

A British Blog highlighted a view that cycling should not be merely associated with youth or championship athletes. Instead, it is perfect for all ages, especially individuals over 60, encouraging enjoyment regardless of age.

Additional online sources offered similar insights, stating, “It’s a great form of exercise for older people … It’s an exercise you can perform at an intensity that suits your needs and abilities, is low-impact, and can be very social if you ride with others.”

There are some good reasons to stop riding as you age

However, some cautions were raised: “If you have health issues or physical limitations that make biking difficult or unsafe, it may be time to reconsider,” and “If you feel unsteady or are at risk of falling, it might be wise to evaluate your biking habits.”

Returning to my perspective, I firmly believe: “If you still enjoy biking and it brings you happiness, there’s no reason to stop.” My primary care doctor echoed this sentiment, recently stating, “The best thing you can do (to slow down aging) is to keep up your exercise.”

One friend’s reaction aligned closely with what I wish a doctor might suggest: “It is an understatement to say that you are doing the right thing by being active and staying active despite a small setback. I support your actions 100%! You are a very diligent and disciplined person. I know you will do well with your recovery. In the meantime you have the opportunity to discover new muscles, new places and new workouts!”

Advice from a 95-year-old: ‘It’s your decision to make!’

Lastly, I sought insight from my cycling friend Joanne Staniscia, who at 95 has shown relentless vitality. She rode her bike until the age of 90, impressing peers with her strength and passion throughout her eighties. Even after a fall at 85 that resulted in a broken wrist, she remained undeterred, stating, “You all continue the ride without me.” Despite receiving medical attention, she returned to biking not long after, and until ages 88 and 89, she was still outpacing me on the hills.

No one suggested to her that she should cease riding outdoors; Joanne concluded that “I just decided at some point that it was time to keep my feet on the ground.” She further advised, “It’s really not for someone else to tell you. You’ll know when you want to stop. It’s your decision to make.”

For now, I’ll allow my elbow to heal completely, cherishing the hope of regaining full motion, and eagerly anticipat my rides next spring.

Reach Sue Scheible at [email protected].

Nd can safely do so, why should you stop?” The joy and fulfillment that cycling brings to my‍ life outweigh ‌the risks involved. While it’s‍ crucial to acknowledge the potential dangers, I value the freedom, companionship, and physical⁤ activity that⁤ biking provides.

In advocating for my right to cycle, I encourage others, particularly older adults, to express their passion for biking while also ‌voicing any concerns during medical appointments. Engaging in open communication can pave the way for respect and understanding, fostering supportive relationships between ⁣patients and their healthcare providers.

My experiences have also made it clear that, while our bodies may change with age, our love for biking doesn’t have to diminish. With appropriate precautions, like safety gear and a careful approach to rides, cycling can remain a lifelong passion.

Ultimately, the question isn’t whether age ⁢should dictate our biking habits, but rather how we can continue to engage ⁣in what we love safely and joyfully, no matter ⁢our age. Cycling is an expression of life,‌ and I intend to embrace it for as long as I can.

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