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This Week in Health Care Reform: July 13th, 2018

Drugmakers face increasing backlash over rising prices; patients find themselves at the mercy of capricious medical emergency fees; and, one company looks to empower consumer decision-making around imaging services.

Week in Review

Drug Price Backlash: After increasing prices on dozens of their products earlier this month, pharmaceutical manufacturer Pfizer announced it would temporarily postpone those price increases after having found itself on the receiving end of a public tongue-lashing from the White House.  That announcement followed a brief conversation between the company’s CEO and the President, the latter having earlier directed scathing criticism at the drugmaker on Twitter.  While the decision was met with measured surprise by some, others were quick to point out that Pfizer was just the latest in a growing list of drug manufacturers to have defied entreaties to refrain from raising prices.

Emergency Fees:
As more focus is placed on identifying cost-drivers within our health care system, increased attention is being paid to the often egregious fees that patients are being charged when forced to seek emergency care.  Consumer advocates point to “after-hours” surcharges as just such an example, which they argue are ridiculous, in light of the fact that emergency rooms are open 24-hours a day.  And, the astronomical charges associated with air ambulance transportation has drawn necessary scrutiny to the relatively few restrictions governing what these private companies are able to get away with charging, which, unsurprisingly, has led to prices for emergency medical flights rising dramatically.  Finally, there’s the recently documented instance of one family being hit with an $18,000 “trauma fee” for their eight-month old son who’d hit his head, but was subsequently discharged with a clean bill of health after a short nap and some infant formula.

Even as momentum continues to shift towards greater consumer empowerment in health care decision-making, many health systems find themselves struggling with the logistics of integrating competitive pricing strategies and transparency into their evolving paradigms.  However, one stakeholder, having identified a traditionally high-cost area – specifically, imaging facilities – has applied its energies to ensuring consumers have the tools they need to make better, well-informed decisions, while also reducing potential barriers to high-value care.  Given that patients often have access to an array of high-quality facilities for things like MRIs and CT scans, Anthem, and its AIM Specialty Health subsidiary, recognized how widely imaging costs can vary from site to site, particularly if performed at a hospital, rather than a freestanding imaging center.  (For instance, one study found that an MRI on a limb can cost up to $1,500 more if done at a hospital.)  So, the company developed its Imaging Clinical Site of Care program which helps identify clinical situations where these services can be performed at freestanding facilities, all the while delivering comparable care to that seen in a hospital setting, but at reduced cost.      

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