UPDATE: July 20, 2020: Years after its passing, the federal government now is trying to argue a section of the Affordable Care Act was meant to force hospitals to reveal confidential rates with insurers, AHA said in its appeal filed on Friday. For nearly a decade, CMS instructed hospitals to provide "gross charges" for its items and services — not negotiated rates. Now, CMS is interpreting that part of the law differently. AHA characterized HHS' latest interpretation of the section in question as "obscure" and "far fetched."
UPDATE: June 24, 2020: The American Hospital Association said it will appeal Tuesday's ruling that upholds the Trump administration's mandate to force hospitals to disclose negotiated rates with insurers. The hospital lobby said it was disappointed in the ruling and will seek expedited review. AHA said the mandate "imposes significant burdens on hospitals at a time when resources are stretched thin and need to be devoted to patient care."
If AHA seeks to have the rule stayed pending an appellate ruling, the decision on such a request "is likely to be almost as significant as this ruling is, since absent a stay, the rule will likely go into effect before the appellate court rules," James Burns, a law partner at Akerman, told Healthcare Dive.
- A federal judge ruled against the American Hospital Association on Tuesday in its lawsuit attempting to block an HHS rule pushing for price transparency. The judge ruled in favor of the department, which requires hospitals to reveal private, negotiated rates with insurers beginning Jan. 1.
- U.S. District Court Judge Carl Nichols, an appointee of President Donald Trump, was swayed neither by AHA's argument that forcing hospitals to publicly disclose rates violates their First Amendment rights by forcing them to reveal proprietary information nor by the claim that it would chill negotiations between providers and payers. The judge characterized the First Amendment argument as "half-hearted."
- Nichols seem convinced that the requirement will empower patients, noting in Tuesday's summary judgment in favor of the administration that "all of the information required to be published by the Final Rule can allow patients to make pricing comparisons between hospitals."
The ruling is a blow for hospitals, which have been adamantly opposed to disclosing their privately negotiated rates since HHS first unveiled its proposal in July 2019. AHA did not immediately reply to a request for comment on whether it planned to appeal.
The legal debate hinges on the definition of "standard charges", which is mentioned in the Affordable Care Act, though it was left largely undefined in the text. Trump issued an executive order last year that included negotiated rates as part of that definition.
Cynthia Fisher, founder of patienrightsadvocate.com, which filed an amicus brief in support of HHS, told Healthcare Dive on Tuesday the ruling could make shopping for health services more like buying groceries or retail.
"For the first time we will be able to know prices before we get care," she said. "This court ruling rejects every claim to keep the secret hidden prices from consumers until after we get care."
Big court victory today for @POTUS’s healthcare agenda. With this decision, we will continue to deliver on President Trump’s promise for “A+” transparency and lower costs for American patients.— Secretary Alex Azar (@SecAzar) June 23, 2020