5 thoughts from hospital leaders on the CMS price transparency rule

Hospitals are now required to post their standard charges online under a CMS price transparency rule.  

The rule, which took effect Jan. 1, requires hospitals to publish their standard charges on the internet. They must present the information in a machine-readable format that can be easily imported into a computer system and update the information at least annually.

Regarding the new rule, healthcare leaders shared the following thoughts.

1. Dawn Bulgarella, CFO of Birmingham, Ala.-based UAB Health System, questioned how helpful posting standard charges online will be for patients seeking estimates for their actual expected out-of-pocket costs. "I don't know how helpful providing hospital charge data will be … because most of our patients want to know what is it going to cost me and that is a function of their insurance, their deductible, have they met their deductible, and if the service going to be provided in an inpatient setting or in the ambulatory setting," she said.

2. Gerilynn Sevenikar, vice president of revenue cycle at San Diego-based Sharp HealthCare, told Becker's the rule aims to provide price transparency, but it may not give patients the ability to search care options and make informed decisions on their care. "Unfortunately, knowing you need a hip replacement [for example] does not give you enough information to look at a chargemaster and know what charges would potentially be billed, what your physician preferences might be, what complications may be likely due to your personal health status, what your insurance would cover and what your out-of- pocket might be," she said.

3. Steve Holman, president and CEO of Terre Haute, Ind.-based Union Health, noted the benefits of the rule. He told WTHI television station: "I think it's important we do everything possible to let patients know what the cost of care is, even though it's complicated. So, I think it's a good thing. I think we just have to evolve as an industry … as hospitals and insurers and such to help that be more transparent."

4. Dave Hensen, assistant vice president of finance at CarolinaEast Health System in New Bern, N.C., addressed the complication involved with figuring out medical costs. "It can be very overwhelming for the consumer to know exactly what they are going to need, and for those patients that have insurance the chargemaster doesn't mean a whole lot because hospitals have contracts with providers that pay us whatever the cost is going to be," he told WITN television station.

5. Michele Muse, director of health information management at Boston-based Tufts Medical Center, expressed optimism about the change. "This rule will allow our No. 1 customer, [patients], to have the flexibility to make well-informed decisions and provide pricing transparency for services across different facilities," she said. "We need to take the time to carefully focus and right staff internally to ensure we are providing the patient with resources to talk through any questions they may have on potential costs in anticipation of their upcoming visits."

 

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