Hospital groups speak out against price transparency in OPPS rule

The country's major hospital associations called a proposed CMS rule that would require hospitals to disclose payer-specific negotiated rates "a misguided attempt to improve price transparency."

The new price transparency requirements were included in the 2020 Outpatient Prospective Payment System rule, which was issued July 29. The rule expands on previous price transparency efforts under the Trump administration, which require hospitals to list standard charges online. The new rule expands the definition of "standard charge" to include gross charges and the payer-specific negotiated rates.

"Hospitals and health systems want to ensure that patients have access to information they need to choose their health care, including their out-of-pocket obligations," says a joint statement from the American Hospital Association, America's Essential Hospitals, the Association of American Medical Colleges, the Children's Hospital Association and the Federation of American Hospitals. "This rule, however, is a misguided attempt to improve price transparency for patients because it fails to give [patients] the information they need."

Under the proposed rule, hospitals will be required to post negotiated rates by payer in a consumer-friendly way for 300 "shoppable" services. Shoppable services are defined as elective, nonurgent procedures. CMS will dictate 70 of the shoppable services and hospitals can choose the remaining 230. CMS believes the shoppable services list will help consumers more easily price-shop for care.

"Disclosing the negotiated rate between insurers and hospitals will not help patients make decisions about their care," the hospital associations said. "Instead, this disclosure could harm patients by reducing patient access to care. This is the wrong approach to price transparency, and the administration should reverse course on this provision."


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