Breast cancer awareness is an important issue in the US
Breast cancer awareness is an important issue in the US. Unsplash

Breast cancer remains one of the most challenging and expensive diseases to treat in the United States. Despite advances in medical technology and treatment options, the financial burden of breast cancer care is staggering. In 2019, Americans faced $3.14 billion in out-of-pocket costs for breast cancer treatment, making it the most costly cancer treatment category. These expenses often push patients and their families into financial hardship, exacerbating the stress of dealing with a serious illness.

Breast cancer treatment involves a range of services, from diagnostic imaging to chemotherapy, surgery, and follow-up care. Even with health insurance, patients frequently encounter high out-of-pocket costs due to deductibles, co-pays, and uncovered expenses. For many, the financial strain is compounded by lost income from taking time off work, making it difficult to cover both medical and everyday living expenses. "People generally do not save for cancer," remarks Rick Louie, Managing Director of Hospital Pricing Specialists (HPS).

The high cost of breast cancer care is symptomatic of broader issues in the healthcare system. One critical challenge is the lack of price transparency. Historically, hospitals and insurers have been reluctant to disclose pricing information, leading to confusion and financial unpredictability for patients. As a result, patients often encounter unexpected bills and struggle to manage their treatment costs effectively.

The transparency regulations introduced in 2019 aimed to address these issues by requiring hospitals to publish their prices and provide tools for patients to estimate out-of-pocket costs. However, the enforcement of these regulations has been inconsistent, and many hospitals have struggled to comply fully. This lack of transparency has perpetuated the cycle of financial hardship for patients.

Even more recently, HPS decided to take a closer look at the issue of mammogram pricing. Their findings revealed that Critical Access Hospitals (CAHs) receive 48% less than the national average for these services. Additionally, there is a significant price disparity between Teaching and Non-Teaching Hospitals. Small hospitals, with lower bed capacities, are reimbursed 22% below the average, while larger hospitals receive 31% above average. Size does matter, at least when it comes to getting paid. These alarming differences clearly show that there is a need for clarification in hospital payment rates.

HPS, a leader in hospital pricing analytics, has been at the forefront of advocating for better data and transparency. "The sheer volume and complexity of pricing data can be overwhelming for both hospitals and patients," Rick explains. "Our goal is to make this data accessible and actionable."

HPS focuses on providing detailed pricing and payer rates reports, patient cost estimator tools and machine-readable files that comply with CMS regulations. These tools help hospitals set defensible pricing strategies and improve their overall net revenue. By benchmarking hospital prices and analyzing payer contracts, HPS helps hospitals navigate the complexities of pricing and reimbursement.

For patients, the ability to access and understand pricing information is crucial. Transparency allows patients to anticipate their out-of-pocket costs and make informed decisions about their care. Yet, despite the availability of pricing data, many patients still face challenges due to the fragmented and often burdensome nature of the information provided.

One of the key benefits of the data provided by HPS is its ability to highlight pricing variations for specific services, such as mammography. By analyzing payment rates for mammography across different hospitals and payers, HPS can reveal significant discrepancies and help hospitals negotiate better rates. For example, HPS can provide insights into the highest and lowest payment rates for mammography, as well as average rates by state or hospital size.

In honor of Breast Cancer Awareness Month, HPS highlights the critical role of data in improving breast cancer care. By providing comprehensive pricing reports and patient cost estimators, HPS aims to alleviate some of the financial pressures faced by patients and support hospitals in setting fair and competitive prices. The company's commitment to data-driven transparency aligns with broader efforts to make healthcare more accessible and equitable for all.

The journey towards transparent pricing in healthcare is ongoing, and the enforcement of regulations continues to evolve. As Rick explains, "The push for transparency is driven by a growing public demand for clarity and fairness in healthcare costs. Increased enforcement and penalties are motivating hospitals to comply, but there is still much work to be done."

For patients, the impact of improved transparency and data accessibility could be life-changing. By reducing the financial burden of breast cancer care and providing clearer information about treatment costs, the healthcare system can better support those affected by this challenging disease.