CMS wants hospitals to post their rates. But hospitals aren’t sure how

by Robert King | Aug 26, 2019

While the Trump administration wants hospitals to begin posting “shoppable” prices online starting next year, some hospitals are scrambling to figure out how they’ll be able to meet such a requirement.

Some officials have complained that they do not have contracts automated in order to post such rates. Others say it will create major problems as they release payer rates with little context for the patients who are supposed to benefit from such transparency.

The Centers for Medicare & Medicaid Services (CMS) proposed the requirement hospitals post payer-negotiated rates for certain shoppable services starting on Jan. 1, 2020, as part of its outpatient payment rule earlier this month. The proposed rule is open for comment now, and CMS must release a final rule by November.

The rates must be available in a consumer-friendly format online and be searchable.

CMS projected in the proposed rule that the cost for implementing the new transparency requirement would be around $1,000 per hospital. However, some hospitals are balking at that figure, because their contract rates with insurers are not automated or online.

“Yesterday, I spoke with a 700-bed hospital in the Midwest that has over 600 contracts,” said Rick Louie, managing director of data analytics consulting firm Hospital Pricing Specialists. “They said it’s virtually impossible to display every contract rate in a searchable form, regardless of infinite time and money. If a 700-bed hospital has these issues, the cash-constrained rural hospitals don’t have a chance.”

OSP INSIDER – Chris J. Stewart, COO & GM, Hospital & ASC Strategy, Ortho Spine Partners

“The current lack of price transparency within the US healthcare system is astounding. Complex contract algorithms and the multifaceted nuances of patient charges, reimbursement and out of pocket expenses has certainly raised the level of financial anxiety for the healthcare consumer, especially in times of medical need and necessity. Hopefully a resolution to this complexity is near, and we as healthcare consumers will not only have access to procedural rate transparency, but also have access to the clinical outcome and patient experience information and will be able to make informed decisions about where we believe the best available care is, at the best price.“


Chris J. Stewart

Chris currently serves as President and CEO of Surgio Health. Chris has close to 20 years of healthcare management experience, with an infinity to improve healthcare delivery through the development and implementation of innovative solutions that result in improved efficiencies, reduction of unnecessary financial & clinical variation, and help achieve better patient outcomes. Previously, Chris was assistant vice president and business unit leader for HPG/HCA. He has presented at numerous healthcare forums on topics that include disruptive innovation, physician engagement, shifting reimbursement models, cost per clinical episode and the future of supply chain delivery.

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