Short- and Long-Term Impact of Price Transparency Rule

Key Takeaways:

  • Hospital charges must be posted online as of Jan. 1, 2019.
  • Due to charges’ limited impact on most reimbursement, Navigant Consulting, Inc. expects actual impact on cost of care to be minimal.
  • This regulation may create additional risks of patients misunderstanding and making clinical choices based on charges, and not actual patient responsibility or necessity of care.
  • Hospitals should prepare for patient, competitor, and media scrutiny of charges despite their limited connection to reimbursement and costs.

In August, the Centers for Medicare & Medicaid Services (CMS) approved a final rule requiring hospitals to make available a list of their current standard charges via the internet in a machine-readable format. The rule, set to go into effect on Jan. 1, 2019, also requires hospitals to update this information at least annually, or more often as appropriate.

The policy will affect all acute-care hospitals, with the stated intention to improve price transparency, empower patient choice, and lower the costs of healthcare. Although CMS has provided little information about the rollout, oversight, and consequences of not meeting this regulation, it creates a critical opportunity for hospitals to own their public approach to describing their charges.

Additional factors of the statute are vague, leaving it up to providers to interpret how much detail to post in terms of their charges, and where. While the rule encourages providers to proactively educate patients about charges and post more vs. less information, it seems to indicate that minimal compliance would be the posting of a charge description master (CDM) or a different summary of service-level charges.

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