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Cancer --- Hospitals --- Treatment. --- Prospective payment. --- Hospital prospective payment --- Hospital prospective reimbursement --- Medicare hospital prospective payment --- Payment, Hospital prospective --- PPS (Medical care) --- Prospective payment, Hospital --- Prospective pricing, Hospital --- Prospective reimbursement, Hospital --- Reimbursement, Hospital prospective --- Diagnosis related groups --- Hospitalization insurance --- Cancer therapy --- Cancer treatment --- Prospective reimbursement --- Rates --- Therapy

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Health insurance --- Excise tax --- Taxation --- Internal revenue --- Taxation of articles of consumption --- Health plans, Prepaid --- Insurance, Health --- Medical care, Prepaid --- Medical insurance --- Prepaid health plans --- Prepaid medical care --- Sickness insurance --- Insurance --- Ambulance service --- Health care reform --- Home care services --- Hospitals --- Medically uninsured persons --- Surgical clinics --- Prospective payment --- Emergency services --- Outpatient services --- Rehabilitation services

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A bipartisan consensus has emerged around the need to address "surprise medical bills," and policymakers have shown a growing interest in using out-of-network payment limits as a tool to control rising health care spending in the United States. Such policies cap the total amount that hospitals and physicians can be paid when they are not in network and prohibit providers from billing patients for an excess balance. Medicare Advantage currently limits payments to out-of-network providers at traditional Medicare payment rates, and the state of Oregon has recently enacted an out-of-network payment limit for its public employee insurance plans. In addition, limits on out-of-network payments to hospitals have been proposed by U.S. senators and 2020 presidential candidates. However, there is a lack of information about the potential impacts of applying such payment limits broadly to hospital services. This lack of information is complicated by the nuanced role that out-of-network limits play in the negotiation process for in-network prices. To fill this gap, RAND researchers estimated the effects that four proposed out-of-network payment limits for hospital care—125 percent of Medicare payments (a strict limit), 200 percent of Medicare payments (a moderate limit), state average payment by private plans (a moderate limit), and 80 percent of average billed charges (a loose limit)⁠—would have on negotiated in-network prices and total payments for hospital care. These four scenarios reflect the variation in base measure (traditional Medicare, market price, and charges) and payment generosity among existing policy proposals.

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Price transparency is one strategy that policymakers have proposed to help consumers identify and select lower-priced health care providers and services, but use of price transparency websites remains low. This report examines current price transparency efforts and their features, describes barriers to more widespread availability and use of price information, and discusses possible ways to overcome those barriers. RAND researchers, together with the Office of the Assistant Secretary for Planning and Evaluation within the U.S. Department of Health and Human Services, convened a panel of experts on price transparency to discuss these issues. Six key themes emerged: (1) Consumers are not often shopping before receiving services, (2) price information is difficult to access during services; (3) price transparency information can be misleading or inaccurate; (4) organizations lack common definitions, standards, and methodologies for sharing price data; (5) increasing the number of state all-payer claims databases may improve stakeholder access to price information; and (6) legal and regulatory barriers prevent the sharing of price data. The panel suggested a number of ways that the federal government could promote the availability and use of price information for stakeholders.