Emergency Physicians’ Response to the Shootings in Dayton and El Paso.

WASHINGTON, DC (August 5, 2019) — In response to shootings in Dayton, Ohio and El Paso, Texas, Vidor Friedman, MD, FACEP, president of the American College of Emergency Physician (ACEP) released the following statement:

“The American College of Emergency Physician (ACEP) joins the nation in mourning and offers our heartfelt condolences to the families, friends and communities forever impacted by the tragic shootings in Dayton, Ohio and El Paso, Texas, this weekend. 

News reports are numbing, and even the most well-intentioned thoughts and prayers fall short. As emergency physicians, we are on the frontlines of treating the victims of these senseless, violent acts. The frequency of firearm injuries and fatalities in this country is staggering, and there is no doubt about the threat posed to America’s public health and safety. 

Firearm injuries—accidental or otherwise—should be addressed as a public health epidemic, with investments in research and a sweeping commitment to change that matches or exceeds the level of a number of diseases, outbreaks or disorders that capture the public conscience but have exacted far less of a human toll in recent years.

In addition to our active participation in the American Foundation for Firearm Injury Reduction in Medicine(AFFIRM)—a non-profit organization founded and led by emergency physicians working to end the epidemic of gun violence through research, innovation and evidence-based practice—ACEP supports legislative, regulatory, and public health efforts that:

  • Encourage the change of societal norms that glorify a culture of violence to one of social civility;  
  • Investigate the effect of socioeconomic and other cultural risk factors on firearm injury and provide public and private funding for firearm safety and injury prevention research;  
  • Create a confidential national firearm injury research registry while encouraging states to establish a uniform approach to tracking and recording firearm related injuries;  
  • Promote access to effective, affordable, and sustainable mental health services;  
  • Protect the duty of physicians and encourage health care provider discussions with patients on firearm safety;  
  • Promote the development of technology that increases firearm safety;  
  • Support universal background checks for firearm transactions;  
  • Require the enforcement of existing laws and support new legislation that prevents high risk and prohibited individuals from obtaining firearms by any means; and
  • Restrict the sale and ownership of weapons, munitions, and large-capacity magazines that are designed for military or law enforcement use.

ACEP also supports further research and legislation to address effectiveness and ramifications of Gun Violence Restraining Orders (GVRO) and Extreme Risk Protection Orders (ERPO), which President Trump mentioned in his national response. ACEP will continue to convene public health and injury prevention experts to review the current state of research and legislation regarding firearm violence.”

Trump price transparency proposals take long bet on curbing costs

Requiring hospitals to display their insurer-negotiated prices online likely won’t lower healthcare spending in the near term. But economists and other experts say it’s a worthwhile experiment in bringing transparency to one of the few industries in which patients often don’t know the cost of a service before they buy it. 

The Trump administration earlier this week issued a proposed rule that would force most hospitals in the country to post on their websites the closely guarded rates for certain healthcare services that they work out with insurance companies behind closed doors. The outcry from hospital and insurance trade associations was swift. 

They argued that patients don’t need to see those negotiated rates because they are interested only in an estimate of out-of-pocket costs, which somehospitals are already providing to patients through online cost transparency tools. Hospital lobbying groups and insurers—who are expected to sue to stop the requirement—warned that exposing the rates could undermine their ability to negotiate with each other.

Hospitals and insurance companies are telling the truth. Evidence has shown that many people don’t shop for healthcare, often because they have trouble finding price information, according to Dr. Ateev Mehrotra, an associate professor at Harvard Medical School who has studied price transparency. He agreed with the hospitals that patients care about out-of-pocket costs, not negotiated rates.

Greg Hagood, president at Solic Capital, said exposing the negotiated prices would likely prevent health insurers from securing deep discounts from hospital systems, and that would translate to higher premiums for their customers. Hospitals would be less likely to give insurers a discount on healthcare services because once publicized, other insurers would demand the same rate, he explained.

“Fundamental to insurance companies being able to offer affordable care is getting discounts,” Hagood said.

Although CMS Administrator Seema Verma said the requirement wouldn’t cost hospitals much to comply with, companies that deploy cost-estimator tools for hospitals today say posting negotiated rates for the dozens of insurers they contract with and the dozens of health plans offered by each insurer would be a massively complicated process and difficult for consumers to navigate on the web. 

“It’s going to be nearly impossible for hospitals to comply with this even if there are stiff penalties,” Paul Shorrosh, CEO of revenue-cycle vendor AccuReg, which has created price-estimator tools for hospitals like Mosaic Life Care. “Each of those (insurance) contracts has multiple payment methodologies depending on whether it’s inpatient or outpatient. The only way to do that is computerize it. There’s no other way. If they publish contracted rates, it’s not going to make sense to anybody.”

But most hospital cost-estimator tools don’t show what patients would pay by going to a competitor down the road. Enabling patients to make an apples-to-apples comparison between providers is exactly what the CMS hopes posting the negotiated rates will allow. Verma suggested to reporters this week that the proposal is only a first step toward transparency and that the agency will fulfill President Donald Trump’s June executive order, which included providing access to out-of-pocket cost estimates. 

Most experts—even the ones who warned of disruption—agreed exposing negotiated rates could lead to positive change in the long run. 

Just getting the secret data out in the open and allowing researchers and policy experts to harness it could help lawmakers create better policy, said Benedic Ippolito, an economist with the American Enterprise Institute. “Tomorrow it may not be the most useful data, but who knows in 10 years,” he said. 

Ippolito also doubted that exposing negotiated rates could lead some lower-cost healthcare providers to raise prices to meet those of higher-cost competitors, as some spectators have predicted. That’s because most hospitals in any given market already have a pretty good idea of others’ prices, he said. 

Paul Hughes-Cromwick, co-director of sustainable health spending strategies at consultancy Altarum, said that revealing rates could indeed lead some hospitals to raise prices, but it could also lead high-priced hospitals to lower their prices, “though this would be tempered by their competitive environment,” he explained.

Bob Berenson, healthcare policy expert at the Urban Institute think tank, along with several other sources, said the proposal could lead to lower prices if the public or policymakers uses the price information to shame high-cost hospitals into bringing their prices down.