Hospitals & Insurers Fight Against Transparency

Hospitals say price transparency won’t lower prices. So what will? 

Hospitals and insurers question legality, need for CMS price transparency rule

by Robert King |

Sep 27, 2019

Hospitals and insurers want the Centers for Medicare & Medicaid Services to get rid of a proposal for facilities to post payer-negotiated rates in a searchable, online format.

Hospitals and insurers are making a last-ditch effort to convince the Trump administration to withdraw a proposal requiring facilities to post payer-negotiated rates online.

Numerous comments on the proposal, which were due Friday, say the Centers for Medicare & Medicaid Services (CMS) will not drive down healthcare costs and will be a pricey burden on facilities. The comments also hint at a likely legal battle that will erupt if CMS goes through with the proposal.

The proposal, included in the 2020 hospital payment rule, would require hospitals starting on Jan. 1, 2020, to post payer-negotiated rates for certain shoppable hospital services. The rates must be available online in a searchable format.

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Hospital groups highlighted the sheer cost of the proposed requirement, which CMS pegs at $1,000 a year, and the American Hospital Association commented that the requirement would “impose a substantial burden on hospitals without a corresponding benefit for patients.”

The Rural Hospital Coalition, a group of small rural, Medicare dependent and sole community hospitals, commented it was concerned about “the additional cost to comply burden for rural providers.”

The coalition also added that the transparency of payer-negotiated rates could “negatively impact the availability of health insurance in rural areas and would put further financial pressure on rural hospitals that are already financially fragile.”

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The American Hospital Association was also worried that the rule could fuel “anticompetitive behavior among commercial insurers in an already highly concentrated insurance industry, seriously limiting the choices available to patients.”

The rule, if finalized, would create an extreme burden for facilities to meet, because they not only have to post negotiated charges for packages of services but also for individual items.