A new proposed federal regulation (called a “rule”) would allow consumers to compare negotiated service prices by hospital and by payer. These would be the real prices paid by insurers, both hospital and payer-specific prices, as well as gross prices. This information could be extremely helpful for consumers without insurance and those with high deductibles to lower their healthcare costs. It could also serve to lower costs across the market for everyone. Prices covered would include at least 300 services, both inpatient and outpatient, and would affect all patients, not just Medicare and Medicaid. Examples include “supplies, procedures, room and board, use of the facility and other items (generally described as facilities fees), services of employed practitioners (generally described as professional charges), and any other items or services for which the hospital has established a charge.” Services covered should be “shoppable” meaning services that are scheduled in advance, such as CT scans or knee replacements. The information must be “consumer-friendly” meaning easy to find, to understand and searchable. It must also include the costs of services that are typically charged with the primary service—no surprise add-ons. The rule would go into effect in January 2020 and would apply to all licensed hospitals.
CMS will take comments on the proposed rule through 5 pm September 27th. Instructions to comment are on page 2 of the proposed rule. Commenters could recommend that prices be updated annually (as proposed) but also whenever a price rises by more than 10 percent. Information should not only be searchable, but consumers should also be able to print, download and send what they find to share with caregivers and family, and to save time finding the same information when it’s needed. It would also be helpful to include median prices, so consumers can see each hospital’s usual price for the service they need, regardless of payer; this could be very helpful for self-pay patients trying to negotiate prices and payment plans.