CMS looking to define enforcement for its hospital price transparency rule 

A man taking cash out of his wallet
The Centers for Medicare & Medicaid Services is seeking feedback on how to best enforce its price transparency requirement. (Getty/lzf)

Now that hospitals are required to post chargemaster data online for patients to access, the Centers for Medicare & Medicaid Services  is exploring the most effective ways to make sure providers comply with the rules. 

CMS Administrator Seema Verma spoke to reporters Thursday morning and said the agency is continuing to gather feedback on what’s next for its price transparency efforts. 

CMS finalized the price transparency requirement in August as part of its Inpatient Prospective Payment System rule. Verma acknowledged concern that providing patients with just the list prices for medical services could have limited usefulness, and said CMS hopes that the machine-readable format leads developers to provide more comparative tools. 

Conference

2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

“We still believe it’s an important first step, and there’s no reason hospitals can’t do more,” Verma said. 

RELATED: How providers, patients could benefit from CMS’ newly instated price transparency rule 

Verma said some hospitals and health systems are already providing more detailed tools, which could serve as an example to peers who may lag behind in transparency. 

One crucial piece the agency is working on is defining enforcement, Verma said. It intends to use the feedback from the request for information to identify the best mechanisms to ensure hospitals are complying. There are also no requirements for where or how the chargemaster lists are posted aside from the data must be machine-readable, so gathering input in this area is also part of the equation.

Verma didn’t set a timeline for any additional rule-making. 

CMS has made price transparency one of the cornerstone pieces to its policies around value-based care. Verma said the lack of patient access to pricing data means they’re “essentially shut out of the process of increasing value.” 

RELATED: Looking for affordable care? Stay away from San Jose 

“We believe patients are the most powerful force in our healthcare system for driving quality and value,” she said. 

Research suggests that patients aren’t flocking to the price transparency tools that already exist, however. They find the data confusing, and in many rural regions, patients can’t comparison shop anyway, as their selection of providers is limited. 

A study from Public Agenda found that patients do want access to this data, but just 1 in 5 report comparing prices, and they may do so in ways beyond online tools, such as asking their physicians or insurers directly.

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