Transparency in Healthcare
By Cristy Gupton
Burke County
When trying to refer to something that’s somewhat simple, we often use the phrase, “It doesn’t take an act of Congress”. Meaning, we should be able to manage this alone without the interference of the government. But, there’s a big issue that Congress actually had to take up on our behalf and it’s causing a huge ruckus. That issue is transparency in healthcare.
Why is it that we have clear and transparent pricing in nearly every aspect of our economy except healthcare? It’s probably easier to figure out what we owe in taxes every year than it is to determine how to read EOBs and hospital bills. I’m sure a smart person once said that they make it difficult to understand simply because they are trying to hide behind the manufactured complexity. Well, in case you missed it, an actual act of Congress was passed in 2021 to tackle this pressing issue. That law was the Consolidated Appropriations Act of 2021. You know, the massive omnibus bill at the end of the year that’s meant to fund the government? Well, some folks who were fed up with opaque healthcare pricing decided to slip language into that law and it took many in healthcare by surprise.
There were basically two parts to the Consolidated Appropriations Act of 2021 of interest to the healthcare industry. First, was the No Surprises Act, which prevents hospitals from generating out-of-network charges from various providers who might happen to treat you at their hospital when the hospital itself is considered “in-network”. Secondly, was a handful of transparency rules. Those are the ones ruffling feathers across the country but here in Western North Carolina, we’re feeling the pain more than most. What makes us so unfortunate? A little company called Hospital Corporation of America or HCA for short. You probably caught the sarcasm there didn’t you? HCA is not little at all. They are the largest healthcare employer in America. What does HCA have to do with the transparency rules that are now the law of the land? Absolutely nothing! Oops, I let more sarcasm slip out. They have nothing to do with transparency because they are one of the hospital systems that is thumbing their nose at the transparency laws, and they couldn’t care less that you might need to know how much your upcoming procedure might cost. Yep, they’re flat-out ignoring their legal requirement to transparently post their pricing so that local patients can make good decisions about where to receive affordable care.
But the transparency laws are not exclusive to hospitals. These new requirements are forcing almost every aspect of the provider side of the healthcare business to come clean with their charges. That means payers, providers, and the intermediaries that hold the once-secret or “proprietary” data that you need to see. Who else is required to play ball in this new transparent environment? Employers and the insurance agents, brokers, and consultants who sell healthcare coverage to them. Yes, Sir! You heard me right. If you are an employer and you sponsor a health plan for your employees, you are legally required to evaluate what your insurance broker is making off of your health, dental, and vision plans. You see, employers who sponsor these plans are considered “fiduciaries”. That’s the same exact word that’s used in retirement plans. So, if employers sponsor retirement plans they are governed by a federal law called ERISA or the Employee Retirement Income Security Act of 1974. I bet that’s kind of surprising that something that was passed that long ago for retirement plans is just now circling back to the same fiduciaries who sponsor health plans. But it’s true.
So, the long-held secret commissions and bonuses, trips and overrides, etc. are supposed to be disclosed to the employers who sponsor those plans. They must evaluate the fees and revenues earned by the brokers, just like stock brokers and financial advisors have had to disclose for years now. It’s time for the insurance industry to get with the program. It’s the law.
Around 2016, I had a major change in my career path. I was working for a large employee benefits consulting firm, and they were being acquired by an even larger consulting firm. I decided to leave and start my own small business, essentially doing the same thing but on a much smaller scale. I knew I needed some infrastructure so I joined a trade group called Health Rosetta. My eyes were opened to a new transparent way of doing business and I was first exposed to the idea that disclosing my compensation was the only way to be totally honest with my clients. I agreed and remembered that being totally transparent was the way Christ would have conducted His business affairs if he were in the same position. I have to remember every day that the job I’ve committed to doing for my clients is my version of ministry. So, being completely transparent about how and what I’m paid is what Christ requires of me. Now employers all over America are required to at least be aware of what their insurance broker is earning from their benefit plans.
An age-old saying goes, “sunlight is the best disinfectant”. If shedding a little light on how your healthcare dollars are being spent is something being denied to you as an employer who sponsors a health plan, then it’s required of you to do something about it. And there’s no better candidate for the job. Employers are often seen as their employee’s advocate, the one who fights for what’s right on their behalf. Kind of like how Christ took up the cross and bore the burdens of his followers.
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Cristy Gupton is an employee benefits advisor based in WNC. She’s vetted by Health Rosetta and Mitigate Partners, two industry groups dedicated to transparency in healthcare. She holds a bachelor’s degree in Public Health from UNC-Chapel Hill and a Master’s degree in Health Benefits Design and Health Informatics from University of Lynchburg. Learn more at www.custombenefits.work.
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