Trump Administration pushing transparency of contracted rates but out-of-pocket is what consumers really want and need

by admin 0 Comments

The Trump administration is considering enforcing increased price transparency in terms of publishing contracted prices between providers and payers, and both groups are pushing back. Providers point to payers. Payers point to providers. Both say that the other is responsible to give meaningful prices to patients.

A recent article in HealthCareDive outlines what could potentially be a game-changer in healthcare. According to the article’s Dive Brief: [1]

  • The Trump administration is considering publicizing the negotiated rates payers make with providers for healthcare services, drugs and medical devices, according to a request for comment tucked in the middle of a 700-page ONC interoperability rule released last month.
  • The request could lead to subsequent HHS rulemaking to mandate price information transparency to help consumers make decisions between hospitals, doctors and other sites of care. It would also eviscerate traditional industry control of price negotiations.
  • The American Hospital Association pushed back, arguing it could limit choices in the private market. “Price is not the only factor that patients weigh when deciding where to receive care. Physician recommendation, quality and location play a significant role,” the group said.

The American Hospital Association also takes the position that the change wouldn’t mean much to consumers. An article in Becker’s Hospital Review reports that “the potential change, which the groups argue is too complex, could also require them to publish prices that mean little to patients, leaders like Tom Nickels, executive vice president of the American Hospital Association, said.”[2]

Both providers and payers have a point because no one has yet come up with a way to take negotiated rates and turn them into meaningful, out-of-pocket prices for the consumer.

Until now. HealthQRS has created the solution for out-of-pocket price transparency.

HealthQRS uses complicated algorithms that use real-time data: the actual payer contracts by provider + insurance verification information + charity + other business rules to provide consumers with a true out-of-pocket per patient per procedure. Let’s repeat that: HealthQRS allows payers AND providers to work together to provide people with their actual out-of-pocket costs. Not estimates.

We also show provider quality scores. We use contract rates, but we don’t publish them. We only publish the out-of-pocket costs. Our system allows consumers to look up a doctor or service or procedure, see a list of quality scores and actual out-of-pocket costs, make an appointment, pay for the service, and even schedule transportation – all from an app on their smartphone. HealthQRS allows you to set business rules that offer pre-pay discounts, terms and even 3rd party financing that consumers can access through the app. We can even give patients access to your telehealth services through the app. We have referral management built in to the system, too, so your providers, including teleprofessionals, can refer to specialists if required.

HealthQRS’ ecommerce platform provides a true retail experience for the user. We are not a portal. HealthQRS has developed the only complete e-commerce platform for healthcare on the market. We are talking about giving consumers a complete, online retail experience that has the look and feel of shopping on Amazon. Give people a way to search for providers and services in network, access quality scores, see the actual out-of-pocket expense, select a provider and service, schedule appointments, pay in full or at least set up payment plans and even arrange transportation. All from an app on their smartphones.

Our solution is simple to use. We invite you to see for yourself with this 2-minute video of the HealthQRS price transparency tool. Click on this link, then you’ll be instructed to download and watch:

HealthQRS interfaces with virtually any existing practice management system and electronic medical record. We have over 30 modules that work independently or all together depending upon your needs to provide a holistic, seamless, total experience for the consumer from start to finish. We combine navigation, the capability to make an appointment, referral management (if needed), payment management and so much more than we can list here.

We enable telehealth connectivity as well. Our technology enables people to connect to more cost-effective, consumer-oriented healthcare options and we keep them in-network. HealthQRS integrates fully to EHRs and can also enhance existing portals and other patient engagement solutions, improve meaningful use numbers and increase meaningful use funds.

Developing a solution of this magnitude didn’t happen overnight. We started with the consumer experience in mind and spent years drawing on the knowledge of best-of-breed experts to perfect, fine tune and put together this complicated, yet complete solution for medical e-commerce.

In fact, HealthQRS has over 15 years of experience developing healthcare retail experiences for people and our founders have over 50 combined years of e-commerce experience. We also invite you to watch our user-friendly app video that you can use to win consumers as well as our point-of-service solution video that may interest you. You can also check out our E-Commerce Medical Marketplace Flyer for more information.

Contact us right now to schedule a personalized demo. We can get you entire system set up in a matter of weeks Looking forward to helping you soon.


[1] Shannon Muchmore and Rebecca Pifer, “Trump admin floats publicizing provider-payer negotiated rates,” HealthCareDive, Mar. 8, 2019,

[2] Morgan Haefner, “Hospitals, insurers poised to challenge Trump’s proposal to disclose negotiated rates,” Becker’s Hospital Review, Mar. 12, 2019,

Leave a reply

Your email address will not be published.

You may use these HTML tags and attributes:

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>