How Providers, Patients Could Benefit From CMS’ Newly Instated Price Transparency Rule

CMS’ price transparency ruleWith the New Year, hospitals are officially mandated to post their list prices online for patients to review.

The Centers for Medicare & Medicaid Services included the price transparency requirement in its Inpatient Prospective Payment System (IPPS) rule, which was finalized in August. As of Jan. 1, every hospital in the country is required to make the price for each of its services accessible via its website.

CMS gave providers limited parameters on how and where to present their data, aside from the fact that the charge master lists must be machine-readable. And that, experts say, is the crucial, overlooked piece in this policy.

A recent poll from PMMC, a revenue cycle management firm, and Healthcare Business Insights found most providers (92%) have concerns about the policy.

The main problem? Hospitals are worried patients could be misinformed or confused by list price data, which doesn’t reflect what they’d pay out of pocket, and that could lead to a public image problem.

In addition, recent research suggests patients don’t flock to price transparency or comparison tools, because they find them confusing. Despite calling for access to such tools, just 1 in 5 patients make use of them, Public Agenda found.

Other groups, such as PwC, have called for hospitals to move away from posting chargemaster data as the sole source for transparency. Based on list prices alone, patients are more likely to choose nontraditional sites of care, PwC’s Health Research Institute said, which can hurt hospitals’ bottom lines.

CMS is encouraging, but not requiring, hospitals to post more in-depth pricing and quality data under the rule. There are no exempted providers, however, and prices for all services offered must be included.

Hospital groups didn’t stage a major fight against the transparency measure, and they may see the benefits in the program and that it’s a crucial step toward a more value-based system.

It’s not able to solve the cost and quality problem by itself, but it is a critical step in moving toward a market-based model that does reflect price and quality.

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