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Hospitals posting prices online is first step, CMS Administrator Seema Verma says

CMS wants to make the rule actionable so that consumers and physicians consider price, creating comparison shopping and competition.

Susan Morse, Senior Editor

A rule requiring hospitals to post their standard charges online is only the first step the Centers for Medicare and Medicaid Services is considering in price transparency, CMS Administrator Seema Verma said today.

CMS is currently gathering comment from stakeholders on the rule that went into effect on January 1.

Verma did not say whether new rulemaking should be expected for 2019, only that CMS looked forward to working with stakeholders in the coming year and was thinking about what the next steps will be.

CMS wants to make price transparency, actionable, so that consumers and physicians use pricing to make decisions, Verma said. This would also create competition in the healthcare market, which would drive down prices.

There is currently a 50-75 percent price discrepancy in certain prices between hospitals in the same region, Verma said.

The rule mandates hospitals post their prices online in a machine, readable format so that consumers can import the information into other documents. This also sets the stage for third parties to develop applications for consumer use, she said.

WHY THIS MATTERS

Hospital CEOs have released statements both in support of the rule and also against, saying it is only confusing consumers, Verma said.

Providers have said the chargemaster price is not an indication of what a patient will actually pay.

Verma said the price transparency approach helps the uninsured  to know what price they will be charged, but it doesn't reveal the cost after additional insurance discounts for those who are insured.

"We're working through these challenges," Verma said. "The solution is not just as simple as revealing prices."

This is an important first step in making healthcare more affordable, she said. Healthcare expenditures continue to rise and patients have been left in the dark on prices.

But hospitals also don't have to wait for CMS to give them clarity on going further to help their patients understand what their care will cost, Verma said.

Some hospitals are combining the chargemaster price with a patient's individual insurance calculation to give them a better idea of cost, she said.

While it's still unusual for consumers to look up prices and shop around when considering surgery or a procedure, individuals who have a high deductible plan may have more interest, Verma said. Doctors making referrals may also want that information, she said.

Congress is interested in consumers caught by surprise billing and legislation is being discussed around that, she said.

TREND

CMS proposed the rule in October.  Starting in 2019, all hospitals have been required to post their prices in a machine-readable format so that the information can be downloaded.

Currently, physician clinics are not under the same requirement.

In the request for information, CMS asked what the enforcement action should be for hospitals that are not following the rule, and also whether clinics should be included.

Other recent CMS efforts in price transparency include eMedicare to evaluate the cost differences between traditional Medicare and Medicare Advantage; a price lookup tool to compare payments and copayments between ambulatory surgical settings and outpatient settings; a policy from the Trump Administration ending gag clauses, which stopped pharmacists from telling consumers whether they would pay less for a prescription if they paid out-of-pocket rather than through using their insurance and a CMS requirement for drug companies to disclose their list prices in television ads.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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