BNA’s Medicare Report™ provides reliable, objective weekly news and analysis of all related legislation, regulation, litigation, and court and administrative...
Oct. 21 — As of Oct. 1, hospitals are required to make lists of their charges for procedures and services public.
That move toward price transparency was supported by major hospital associations, according to comments representatives from both the Federation of American Hospitals and the American Hospital Association made to Bloomberg BNA.
However, a former CMS official now representing a state hospital association said the price transparency requirement is vague, which he said makes it difficult for hospitals to comply with the rule.
The requirement was in the Medicare hospital inpatient prospective payment system (IPPS) final rule issued Aug. 22.
According to the IPPS final rule, the Affordable Care Act amended Section2718(e) of the Public Health Service Act to require each hospital in the country to establish and make public a list of the hospital's prices for procedures. In addition, the ACA required hospitals to update their price list annually. The rule took effect Oct. 1.
Jeff Micklos, FAH executive vice president and general counsel, told Bloomberg BNA Oct. 21 that his group appreciated that the CMS allowed hospitals to meet the price transparency requirement in a flexible manner.
The final rule said “hospitals are in the best position to determine the exact manner and method by which to make” the price list public. The rule never specified if the price list has to be posted in a specific place, whether online or at a physical location.
The rule said hospital charges are often billed, in full, to uninsured patients who cannot benefit from discounts negotiated by insurance companies.
As such, Micklos said insurers are important to price transparency efforts. Insured patients should check with their insurer about prices for hospital procedures and treatments, he said.
However, Herb Kuhn, president and chief executive officer of the Missouri Hospital Association, said the price transparency requirement was “very general” in an Oct. 21 e-mail to Bloomberg BNA.
Kuhn, who formerly was director of the CMS's Center for Medicare Management, said the general nature of the rule “makes it difficult for hospitals to know exactly how to meet it, other than CMS encouraging hospitals to engage in a consumer friendly manner to meet the standard.”
Currently, Kuhn said, “[W]e are encouraging hospitals to post their charges for common procedures or post the information on how individuals can obtain that information. Perhaps in the future CMS will issue some sub-regulatory guidance to provide more clarification.”
In addition, Kuhn said his association is unaware of any penalties that apply should a hospital fail to comply with the new standard.
The Missouri Hospital Association is based in Jefferson City, Mo.
In an Oct. 21 statement e-mailed to Bloomberg BNA, AHA spokeswoman Carly Moore said, “The AHA has long supported the need to provide patients with health care price and quality information and has worked with stakeholders, including HFMA [Healthcare Financial Management Association], to provide useful information that will help patients make health care decisions.”
The AHA has developed tools and resources to assist member institutions make price information available to patients, Moore said.
She told BNA that “[p]roviding understandable and useful information about the price of hospital care is one of the ways America's hospitals are working to improve the health of their communities.”
To contact the reporter on this story: Michael D. Williamson in Washington at email@example.com
To contact the editor responsible for this story: Brian Broderick at firstname.lastname@example.org
Information about the price transparency requirement is on pages 50,145 and 50,146 of the IPPS final rule at http://www.gpo.gov/fdsys/pkg/FR-2014-08-22/pdf/2014-18545.pdf.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to email@example.com.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to firstname.lastname@example.org.
Put me on standing order
Notify me when new releases are available (no standing order will be created)