The hospital price transparency rule went into effect on Jan. 1. The regulation from the Centers for Medicare & Medicaid Services requires hospitals to provide cost information for medical procedures that can be scheduled in advance.
Jolene Calla, vice president of healthcare finance and insurance at the Hospital and Healthsystem Association of Pennsylvania, says the new rule has two goals. “One is to promote competition, and the other is to give patients the information that they need to make healthcare decisions and ultimately bring down the cost of care,” she explains.
The rule requires hospitals to post prices for 300 “shoppable services,” which it defines as “a service package that can be scheduled by a healthcare consumer in advance.” CMS specifies 70 common services that all hospitals have to price, and the other 230 are up to individual facilities to select.
Some critics have said the rule will create more confusion than clarity, as the long lists of numbers don’t necessarily reflect individual patients’ circumstances.
Calla says, “I think it is achieving the goal of putting information out there so patients who might want to look for things can find it, but the problem with that is it doesn’t tell the whole story,” noting that, “while there are standard charges, there are no standard patients.”
Penn Medicine Lancaster General Health links to their list of standard charges, or Charge Description Master, on their website, but adds the caveat:
“In our opinion, the CDM itself does not provide the appropriate price transparency for the patient as a patient’s out-of-pocket cost is not determined by the standard charges of a hospital. The out-of-pocket cost is driven primarily by:
1. The contracted rate that the patient’s insurance carrier will pay the hospital which is generally much less than the standard charges; and
2. Any copay, deductible, or coinsurance required by the patient’s benefit plan.”
Some hospitals offer cost estimation tools on their websites that enable patients to input more specific personal information, but Calla says the best way to get a price estimate that is as accurate as possible is to call the hospital.
“Talk directly with the hospital — first with your doctor to make sure you’re getting the care you need, and then with a billing specialist or a patient advocate,” encourages Calla.
Calla says that hospitals have been working on meeting the price transparency rule’s requirements for about a year, “but nobody expected to be doing it in the midst of a national public health emergency.”
The COVID-19 pandemic may have slowed some facilities’ efforts as they prioritized patient care, but Calla says hospitals are working toward compliance if they aren’t fulfilling the requirements already.
The full price transparency rule can be read here.
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