CMS Administrator Seema Verma calls the new rule a small step. We couldn’t agree more!
According to recent reports, what was touted as a giant step for healthcare cost transparency has turned out to be little more than a puzzle few can solve. The rule, which took effect on January 1, 2019, requires that hospitals post their prices online in a machine-readable format for consumers to download. The problem is that the price lists, which payers refer to as chargemasters, break common procedures into retail-priced, coded components that are meaningless to the general consumer.
A law professor describes chargemasters as huge spreadsheets containing complex codes that only a billing expert could interpret. Determining the cost of a visit to the ER, for example, would require knowing the codes and locating the costs for all parts involved in the visit. Really? If the goal is to help people understand what medical services really cost, shouldn’t hospitals display prices they accept from health plans, or at least a typical range from low to high?
The Goal Is to Help Who?
HHS is currently seeking public comment on whether or not patients should have the right to see discounted or negotiated prices before choosing a provider. While most providers and payers and their respective associations cite antitrust violations and other concerns, it seems that providing healthcare consumers with price information in an easy-to-understand format could be a BIG step towards lowering costs for health plans and plan members. Isn’t that what healthcare cost transparency is supposed to do?