Hospitals Shun Sunshine – Embrace Foggy Days

“We are very disappointed that CMS continues down the unlawful path of requiring hospitals to disclose privately negotiated contract terms,” the group said in a statement………….

Article Referred By Glenn McClellan

Hospitals balk as CMS doubles down on price transparency

AUTHOR Shannon Muchmore@stmuchmore

PUBLISHED May 12, 2020

Dive Brief:

  • CMS is adding a new element to controversial price transparency regulations, suggesting it will continue to collect data on hospital median payer-specific negotiated rates and consider how that information could be used to set set relative Medicare payment rates. Hospitals immediately blasted the idea.
  • In the draft of the Medicare Hospital Inpatient Prospective Payment system for fiscal 2021 posted Monday, the agency also proposed raising the rate for inpatient hospital services by about 1.6%, which would amount to nearly $2.1 billion.
  • The IPPS draft rule would also create a new diagnosis-related group, or billing code, for CAR T-cell therapies for cancer treatment to help “predictably compensate hospitals for their costs” and “provide payment flexibility” as new therapies become available.

Dive Insight:

The American Hospital Association, which is suing HHS for earlier price transparency efforts, did not mince words when responding to the draft Monday evening.

“We are very disappointed that CMS continues down the unlawful path of requiring hospitals to disclose privately negotiated contract terms,” the group said in a statement. “The disclosure of privately negotiated rates will not further CMS’s goal of paying market rates that reflect the cost of delivering care. These rates take into account any number of unique circumstances between a private payer and a hospital and simply are not relevant for fixing Fee-for-Service Medicare reimbursement.”

In arguments last week in the U.S. District Court for the District of Columbia, AHA argued the mandates to disclose secret negotiated prices violate the First Amendment, as the data are protected proprietary information.

CMS had said it would update its proposal for the hospital star ratings methodology in the draft rule, but the agency will now hold off until future rulemaking because of pressures from regulatory adaptions to the COVID-19 pandemic. Hospitals have said the ratings are flawed and don’t provide accurate and useful information on care quality.

In an update to its inpatient quality reporting program, CMS is proposing to progressively increase the number of quarters hospitals are required to report electronic clinical quality measures, starting with two quarters in 2021 and reaching four quarters for 2023 and beyond.

The rule also proposes publicly reporting the eCQM data for the first time, beginning with calendar year 2021.

CMS had hinted at the CAR-T reimbursement change earlier. Currently, payment is under a category for stem cell and bone marrow transplants with a new technology add-on payment and is likely to leave hospitals at a loss.

In the draft payment rule, the agency also proposes 24 new applications for add-on payments and expanding the pathway for antimicrobial products that FDA has designated as a Qualified Infectious Disease Product to include products approved under FDA’s Limited Population Pathway for Antibacterial and Antifungal Drugs.

CMS Administrator Seema Verma said on Twitter the change will create a more streamlined process for certain antimicrobial products, “speeding up beneficiary access to critical therapies they need.”

The IPPS also outlines uncompensated care payments to disproportionate share hospitals for FY 2021, which it estimates will be $7.8 billion, down about $500 million from the previous fiscal year.

Comments on the proposed rule are due July 10.


NOTE: There are no secrets anymore. Anyone can get the data on managed care contracts if they look in the right places. We know what’s in these “secret” agreements and we know why hospitals don’t want you to know what’s in them. When you are prohibited from reading a contract, or auditing it’s terms, that usually means you’re paying too much. And in this case, you are. Note to hospitals: The Jig Is Up