In its quest to improve price transparency, the Centers for Medicare and Medicaid is on the hunt for a company that has the expertise to help it create a price comparison tool for consumers to check prices at hospitals.
That’s according to Modern Healthcare, which says that despite industry opposition, CMS is plunging ahead with its plan. Why the opposition? According to industry arguments against the action, the cost of any given procedure is more dependent on the kind of insurance carried by the consumer, not the provider of the procedure.
But CMS isn’t having any of that argument and has updated its previous pricing transparency guideline taken from the Affordable Care Act to now require “hospitals to publish a list of standard charges in an online, machine-readable format starting Jan. 1.” In addition, hospitals “must update that charge information, drawn from their retail chargemaster list, at least annually.”
According to Modern Healthcare, while CMS has released a sources-sought notice to see if any companies have the expertise to create the consumer tool, it’s not clear whether that action is related to the update to the pricing transparency guideline. However, CMS did say earlier in the month in a rulemaking statement that it’s working on determining what other actions it should take to make sure that hospitals display price information in a way that’s most useful to consumers so that they can more easily compare providers on price and quality.
The sources-sought notice requires that contractors responding “must have experience with transmitting and storing medical provider information and using bid or auction data for healthcare procedures. Responding companies should also have specific experience supporting provider pricing and transparency efforts and currently offer support for the development and maintenance of web-based price comparison tools, bidding systems and applications.”
“Ask any hospital, lab or physician the price of anything and all you ever get back is a question: ‘What insurance do you have?’” Steven Weissman, an attorney and former hospital president, told Modern Healthcare. “Each patient’s price depends on how much can be extracted.”
And according to the American Hospital Association and other hospital industry sources, the right source for pricing data should be payers, not hospitals, since those prices will determine what consumers will end up paying out of pocket. They also dismiss provider charge and payment data are proprietary, and not useful to consumers who want to know what their own bottom-line cost will be.
Again, CMS dismissed such arguments this month in a rulemaking, saying “nothing justifies a delay in the provision of chargemaster information to the public.”