Dive Brief:
- The Obama administration has approved health plans putting hard payment caps on certain medical procedures, a practice known as "reference pricing," reports FierceHealthPayer.
- With reference pricing, health plans will only pay a specific amount for certain procedures, leaving patients to pay the difference between hospital charges and health plan reimbursement.
- Under guidelines issued by HHS, the amounts patients are expected to pay could exceed the out-of-pocket limits spelled out under the ACA.
Dive Insight:
Reference pricing can save payers and employers a great deal of money. For example, it saves an average of $10,367 per knee or hip replacement procedure, according to a study by the Employee Benefit Research Institute, FierceHealthPayer notes. But with the difference between the reference price and the hospital charge falling on patients, it's likely hospitals will face problems with collections. With these extra charges piled on top of high deductibles, patients are unlikely to be able to afford the difference.