Piggy banks with calculator and stethoscope

The health care industry has less than a year until a CMS rule requiring hospitals and health systems to post negotiated rates for patient procedures takes effect, and many stakeholders are using that time to do whatever they can to avert its implementation and avoid having to disclose the closely held details of their negotiated rates.

In the latest development, the Alliance of Community Health Plans, a group of non-profit health plans, is proposing a set of guidelines for certifying price estimator tools, which currently can be incredibly confusing for consumers and offer inaccurate price information.

"The average family wants to know is the service covered, how much they'll pay on their deductible and copays, and how far they'll have to drive," said Ceci Connolly, CEO of ACHP. "This is our attempt to move forward on something that matters to consumers."

The hope is that if the health care industry can create its own satisfactory solution to price transparency, it can avert the burdensome requirements of the CMS rule.

Though ACHP's plan is scarce on details as to how it would ensure pricing accuracy, it does address one common issue with price estimator tools: getting consumers to use them. The proposal includes engagement strategies such as shared savings for those who opt for a lower-cost provider.

Others in the health care industry told Modern Healthcare that the proposal just doesn't go far enough in creating true transparency. "Showing negotiated rates matters to employers and purchasers in terms of making the marketplace more functional," said Suzanne Delbanco, executive director of Catalyst for Payment Reform. "I've heard every argument against transparency, but I don't think we're doing so well without it."

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Alliance calls for voluntary adoption of price transparency tools

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