New Centers for Medicare and Medicaid Services (CMS) price transparency requirements for hospitals took effect Jan. 1: Hospitals must now publish their standard charges online.
In an age characterized by consumers’ ability to shop for virtually anything online, and to compare prices instantly, it’s remarkable that consumers of health care services have not enjoyed a similar ability to understand exactly how much they are paying for a specific hospital procedure or service.
The physicians, hospitals and other providers in your clients’ health insurance provider networks believe that, to an extent, the payers’ role explains the lack of transparency. When bills for services and explanation of benefits arrive in the patient’s mailbox, it’s after the event. The cost is already incurred. And, moreover, it takes a bona fide medical benefits expert to deconstruct the invoices.
Patients have learned to live with the fact that hospital procedure costs are shrouded in obfuscation. But, with consumers taking an increasingly empowered role in their own health outcomes, and, given the reality that many health plans are calling for bigger co-pays and higher deductibles, murky and ambiguous pricing can no longer stand.
Although consumers may not yet be broadly aware of the new CMS hospital price disclosure regulation, hospitals across the United States are aware. They have started to publish their charges.
So far, the way the information is posted varies widely and, not surprisingly, isn’t necessarily easy to digest. Spectrum Health,for example, posts its average charges. Rush University Medical Center simply posts a spreadsheet of its chargemaster.
The new CMS hospital price disclosure requirement is the first step by CMS toward putting stronger parameters around pricing transparency. Word will spread, and sooner, rather than later, hospitals will stop hiding their charges behind a curtain of opacity. Hospitals will need to adopt a far more consumer-friendly attitude. They’ll not only have to price competitively, but they’ll also have to show your individual health insurance clients, and your group health customers’ employees, why consumers should select them over competitors.
Hospitals will have to tell consumers what the consumers are getting, and at what price, and why their facilities are the best option.