Cynthia Fisher on Hospital and Insurance Company Price Gouging

When President Donald Trump issued a rule requiring hospitals and insurance companies to post their prices online, liberals were confused.

Cynthia Fisher
Patients Rights Advocate

“Wait a second,” they asked.

“Who persuaded that guy to do something good like that?”

Turns out it was Cynthia Fisher, the founder and chair of

Her mission – to force health care providers and insurance companies to post their prices online. 

Fisher met President Trump at – you guessed it – a golf course in New Jersey and buttonholed him about her favorite cause.

She had standing with the President.

Fisher, married to Jim Koch, co-founder of Samuel Adams maker Boston Beer Co., was a major donor to Republican candidates – donating $1 million to them in the 2018 cycle. 

“We founded to make sure that we stop highway robbery in health care,” Fisher told Corporate Crime Reporter in an interview last week. “Every day, patients are blind to the prices they are going to be charged by the health care industrial complex. They have been blindsided by outrageous overcharges and price gouging. Before they even get sick they are agreeing that they will pay whatever they will be charged.” 

“The Affordable Care Act gave patients the right to know all standard charges in healthcare before they get care. President Trump put it into effect with an executive order. That order required hospitals, as of January of this year, to show their prices with every health plan and every insurer, all posted up front and online as well as all discounted cash prices.”

“And starting next year, health insurance companies will be required to post all prices, negotiated rates online up front, as well as provide the actual prices they pay – their health claims data.” 

“This will be a huge win for American consumers when this data is unleashed system wide. It will lower costs by our choices and it will help make health care affordable and accessible to all Americans.”

One of the reporters who has been at the forefront of reporting on surprise medical bills has been Sarah Kliff at the New York Times. Have you been in touch with her?

“Yes. We have been in touch with Sarah Kliff. And we have been in touch with the people she has written about, people who have been gouged and overcharged. And we have taken some of their bills and helped them with their cases and showed how the hospitals sometimes erroneously billed some of the people she has written about.” 

“There are honest doctors out there who have left this horrid capitalist system of greed that has been overbaked by the entire health care industrial complex.” 

“Over the past couple of decades, the pharmaceutical industry, the pharmacy benefit managers, the health insurance industry, the hospitals have come together to maximize their revenues and capitalize on the patient’s misfortune by upcharging and upcoding to the maximum level of revenues and profits. And that has come to a great misfortune to consumers.” 

“Now we have seen reports showing that 64 percent of the people in the United States sit on the sidelines and don’t go and get the healthcare they need because of fear of financial ruin.”

“And we know that ninety percent of Americans want to know – what is this going to cost? They want this transparency.”

“Businesses are now incentivizing employees to go to the places with the best quality and best prices. As a result, they are giving bonuses to employees and increasing their wages. They have been changing health care for the better by making it so much more affordable and accessible.” 

“There are now surgical centers at the forefront of this transparency movement – Texas Free Market Surgery Center, Surgery Center of Oklahoma, OSS Surgical Center in York Pennsylvania. Employers are sending their employees, paying for their travel and for the travel of a significant other to these centers and they are still saving money.” 

“They were able to save tens of thousands of dollars on a knee replacement. They were paying $16,500, including rehabilitation, instead of $65,000 or $75,000 in an opaque hospital system that upcodes to the maximum.”

“We brought these businesses and the patients into the last administration to tell the stories of how they were changing things for the better. No matter where we go as a country, even to Medicare for All, it’s going to be a step by step approach to get there. Pulling back the curtain to see these prices is the foundation to get quality care at the lowest possible price. People need to know where they need to go.”

“We say we can save $1 trillion of the $4 trillion we spend on health care every year. 

“There was a Journal of the American Medical Association article that showed that 25 percent of our health care costs are administrative, fraud and error. And if you don’t know the price to begin with, how can you know whether you have been fraudulently billed, or overcharged, or erroneously billed?”

Single payer advocate Kip Sullivan says that for a medical good or service to be shoppable, four conditions must be met – the need for the service must not be urgent, accurate and intelligible price (and ideally quality) information must be readily available,  multiple providers of the good or service must exist within the patient’s market, and the cost of the good or service cannot exceed the patient’s deductible (or what’s left of it). 

Let’s go over a couple of those. Urgency. 

If you are a gunshot victim, you are not in a position to shop around for an emergency room.

“Correct. But say you cut yourself slicing an apple and you need stiches. The nice thing about having transparency in health care is that it does pull back the curtain to know if that emergency room or that urgent care visit is competitive.” 

“There is an urgent care center here – the Brigham and Women’s Hospital Urgent Care – I would know up front that they were going to charge me a $200 facilities fee compared to an urgent care facility that doesn’t charge me a facilities fee. Some of these hospitals charge additional codes that cost the consumers much more. I could prevent being charged that fee if I knew where to go.”

“It is also normalizing. Look what it does in the tech economy by making cell phones affordable to so many people. And that’s in part due to competitive pricing.” 

“But I agree if you are in an urgent situation, it’s not a time to shop.”

Kip Sullivan says that second, the information has to be accurate, intelligible and readily available. He says that information available today is often neither accurate nor intelligible. The few hospital transparency websites he has visited he says are loaded with jargon, and comparing one jargon-filled website to another will drive you crazy.

“We released a report on hospital compliance six months into the rule being in effect. Starting January 1, 2021, hospitals were required to post their prices online, up front and clearly by all payers and all plans.We found that only 5.6 percent of a randomized 500 hospitals representing every state in this country complies with this law.”

“And often there was obfuscation built into how this information was presented. The good news is that there are technology compares like Turquoise Health, FireLight Health and many others beginning to create inroads to do comparative pricing.”

“The good news is that the Biden administration did raise the fines. A big part of this is enforcement. To date, HHS has sent out hundreds of letters to non compliant hospitals. Obviously, thousands of hospitals are not in compliance. We have not heard of any enforcement yet, however, the Biden administration just issued new rules as of last week that have raised the penalties to up to $2 million per hospital. That’s not enough but it’s a beginning.”

Are there criminal provisions?

“Not yet. I do think that a hospitals’ license should be put into question if they are not transparent to their customers about their pricing.”

Is there a website where you can go to compare prices of hospitals in your area?

“Not yet. But there is an example in the pharmaceutical field. It’s called GoodRx. You can go to that website and compare drug prices. That type of application is just around the corner for hospital prices. Search engines like Google or Yahoo or mobile apps should be going online as early as next year with this data for hospitals.”

[For the complete Interview with Cynthia Fisher, see 35 Corporate Crime Reporter 45 (11), Monday November 22, 2021, print edition only.]

Copyright © Corporate Crime Reporter
In Print 48 Weeks A Year

Built on Notes Blog Core
Powered by WordPress