The primary concern is there will be no view into the long-term cost of care. The required healthcare pricing information simply shows the transactional price of a particular current procedural terminology (“CPT”) code or diagnosis-related group (“DRG”), rather than a true view of the entire care episode. For example, if a participant was interested in the pricing for knee surgery, the current regulations (for employers and providers) only require individual CPT codes. However, most procedures involve a host of codes from a variety of providers. The rule would now require the disclosure of this additional information and participants may expect the information to lead to lower health care costs.
A truly holistic healthcare transparency experience (cost and quality of care) requires participants to obtain information related to the transactional cost, episodic cost, out-of-pocket cost and quality of care information (e.g., outcomes, risks, and dangers). The best view will also capture the extent to which providers pursue particular treatment paths. A provider with a slightly higher cost, but a lower tendency to order a given treatment, will on average be a more cost-effective provider.