Hospital price transparency rule could come before year's end, White House adviser says

CMS could release a rule by the end of 2019 on a proposal that hospitals disclose payer-specific negotiated rates, a White House adviser said. 

"We'll have hopefully another announcement this month, maybe in December, but I'm hopeful this month," White House Domestic Policy Director Joe Grogan told attendees of an Alliance for Health Policy event last week 

A video of the event was posted by C-SPAN.

"That is going to gore a lot of oxes," Mr. Grogan said. "There are a lot of people who do not want customers and the American people to see where the money goes in the healthcare system. They thrive on opacity. They thrive on the arbitrage created by the lack of transparency in the healthcare market. There's a lot of money flowing through the healthcare system, and unless we get at confronting some of the vested interests that have been making a lot of money year after year on this, the American people are going to continue to be exposed."

CMS is delaying action on the price transparency proposal, excluding it from the 2020 Medicare Outpatient Prospective Payment System final rule released Nov. 2.

The proposal, which CMS released July 29, includes provisions in a price transparency executive order signed this year by President Donald Trump. It would require hospitals to publish all "standard charges," including the hospital's gross charges and negotiated rates with payers for an item or service, online in a machine-readable format.

Under the rule, hospitals also would be required to publish the rates they negotiate with insurers for 300 services consumers are likely to shop for in a searchable and consumer-friendly manner. Hospitals that don't comply would be penalized.

The proposal builds on a current federal rule that requires hospitals to publish a list of their standard charges on the internet, but excludes negotiated rates with payers. 

The American Hospital Association has come out against the proposal, saying it is "the wrong approach" and "would introduce confusion and fuel anticompetitive behavior among commercial health insurers."

Federal contend the proposal could significantly reduce healthcare costs. 


More articles on healthcare finance: 

CMS reimbursements delayed under new skilled nursing facility payment model
CMS urged to cut prior authorization red tape
Hospitals seek to stop January Medicare reimbursement cuts to off-site clinics

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