CMS Continues Push for Transparency

Following last year’s controversial price transparency rule mandating that hospitals disclose the rates they negotiate with insurers online for specific services, payers have decided to counter the rule with an initiative of their own.

The Centers for Medicare and Medicaid Services (CMS) revealed the list of 70 mandated services hospitals are required to publish the payer-specific rates of in December 2019. The rule, however, is still facing pushback from health plans.

In an attempt to divert the Trump administration’s price transparency efforts, the Alliance of Community Health Plans introduced a framework on Feb. 18 for certifying online tools that provide accurate and accessible price information to consumers shopping around for medical services–essentially, a certified price estimator. Given price estimators are ubiquitous among insurers and hospital sites, the non-profit contends there is no certification process implemented for such tools.

Instead of mandating the publication of payer negotiated rates, the group is proposing a voluntary approach that places the responsibility to provide reliable out-of-pocket estimates in the hands of the health plans.

The rule, finalized in November, is set to take effect in 2021, a timeline Health Care Cost Institute CEO Niall Brennan, believes is too ambitious. Brennan told Modern Healthcare the proposal may be too late to change the administration’s trajectory.

Hospitals however have already challenged the rule in federal court. The Department of Health and Human Services (HHS) has already reacted with a motion to dismiss.

“The only thing standing between the current situation and pretty radical provider/payer-specific price transparency is a judge,” Brennan said.

The HHS filed a brief as a response to the lawsuit, stating in part,

“At bottom, everyone agrees that consumers are fumbling in the dark for information about how much their hospital care will cost.”

Hospitals argue that publicizing the charges can cause more confusion among consumers than clarity as a majority will not have to pay the listed out of pocket prices. Providers instead are advocating for publicizing a price that patients will owe after taking into account relevant discounted rates, deductibles and copays.

Check out Modern Healthcare and Revcycle Intelligence for more on the price transparency rule.

View all “shoppable services” providers will be required to disclose here.

Also, take a look at the final rule on the HHS site.

And check out the HHS brief here.