Hospital noncompliance with CMS price transparency rule: What ASCs need to know

CMS' rule to make hospital pricing readily available to patients went into effect Jan. 1, and while many hospitals aren't complying, some expect ASCs to move toward price transparency. 

The law requires hospitals to post a machine-readable file with the negotiated rates for all items and services and to display the prices of 300 shoppable services in a consumer-friendly format. 

However, a June 21 study by The American Journal of Managed Care showed that many hospitals still are not fully compliant.

And despite the rule, it's still common for patients to overpay for their tests and lab work, according to research released by pharmacy discount company GoodRx.

Some leaders think price transparency could benefit ASCs.

"Allowing patients to pull back the curtain will help them make informed decisions regarding their care," Andrew Gwinnell, executive director of Truvista Surgery Center in Detroit, told Becker's. "Our value proposition of high quality care at lower costs will be more accessible and further highlighted for the public."

In April, CMS proposed repealing the requirement for reporting median payer-specific negotiated rates in 2022, saying it would reduce the administrative burden on hospitals by around 64,000 hours. 

While ASCs are not required to post prices online, some centers have bundled prices available to attract cash-paying patients or individuals with high-deductible health plans. Other ASCs are beginning to post prices ahead of the curve. 

"I think we all need to be moving towards complete price transparency — with prices posted on the website for all to see. We are in the process of doing this currently. I am confident everyone will be there in the next few years," Vishal Mehta, MD, president and managing partner of Geneva, Ill.-based Fox Valley Orthopedics Ambulatory Surgery Center, told Becker's.

Price transparency for surgeries isn't always clear-cut, making it difficult for ASCs to be fully transparent, Michael Patterson, CEO and president of Mississippi Valley Surgery Center & Endoscopy Center in Davenport, Iowa, told Becker's. Often, prices are dependent on what surgeons discover once the procedure begins, he said.

"I believe every effort should be given to help patients understand their costs upfront. The complexity of payer contracts, coding, co-insurance, co-payments, etc., make it challenging," he said. "Our job as an industry should be to educate the patient, allow them to make decisions about their care and be there to support them after their surgery with any billing questions they might have."

For hospitals, CMS started issuing its first round of warning letters to those not in compliance with the hospital price disclosure rule, a CMS spokesperson confirmed to Becker's May 5. 

"Some hospitals and some ASCs charge outrageous fees, and these should be published. This should be by law and not voluntary," R. Kemp Massengill, MD, an ophthalmologist in Palos Verdes Estates, Calif., told Becker's.

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