CMS may require hospitals to post price, payer negotiated rates online — what does it mean for ASCs?

The CMS Medicare Outpatient Prospective Payment System 2020 proposed rule included a requirement for hospitals to publish standard prices and payer-specific negotiated rates.

Hospitals would be required to publish the negotiated rates for 300 services patients are most likely to shop for; CMS defined 70 of those services. The hospitals would be responsible for publishing rates in an easily accessible way. Hospitals that fail to comply face fines totaling up to $300 per day. 

The American Hospital Association is not pleased with the proposal, and plans to fight back if CMS finalizes that aspect of the rule. In a joint statement with other hospital associations, the AHA stated: "Hospitals and health systems want to ensure patients have access to information they need to choose their healthcare, including out-of-pocket obligations. This rule, however, is a misguided attempt to improve price transparency for patients because it fails to give them the information they need."

The statement goes on to proclaim making negotiated rates with insurance companies public wouldn't improve patient decision-making and could reduce access to care. Bloomberg Law reported insurance companies may also fight against making negotiated rates public.

How would this affect ASCs?

ASCA CEO William Prentice addressed this in an interview posted on the ASCA website: "If approved, the requirement that hospitals post their negotiated prices will likely spur CMS to expand that requirement to other providers over time. We will be paying close attention as this proposal moves forward and will keep our members apprised of all developments."

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