PRA Sends CMS Recommendations to Strengthen Hospital Price Transparency
PatientRightsAdvocate.org sent the Center for Medicare & Medicaid Services (CMS) a letter and one-pager of recommendations on how it can finally deliver actual healthcare prices to consumers by taking actionable steps in its forthcoming CY 2022 OPPS Rule currently being drafted. PRA’s letter highlights the widespread noncompliance with the hospital price transparency rule and provides the following recommendations to deliver meaningful healthcare price transparency to lower the costs of care and coverage:
Recommendations to Strengthen the OPPS Rule, actionable by January 1, 2022
Enact Higher Penalties for hospital noncompliance: $300 per day per licensed bed per hospital.
Enforce Penalties Robustly and Timely for Noncompliance.
Implement and Enforce Clear Standards starting Jan. 1, 2022 to unleash all actual price information to consumers, technology innovators, and search engines to usher in online shopping tools.
Require Hospitals to Notify All Patients before care that all discounted cash prices and negotiated insurance prices are posted online.
Recommendations for the CY 2022 OPPS Rule, actionable by January 1, 2023:
Eliminate price estimates which offer no accountability and confuse patients. Instead, mandate hospitals publish total, bundled, complete actual prices upfront – both in the data file and the shopping tool.
Require hospitals to provide consumer protection and billing remediation service for easy recourse and remedy when medical bills do not match the agreed upon, upfront price.
Read the full letter HERE.
Cynthia A. Fisher, PRA founder and chair, has an op-ed in RealClearHealth highlighting hospitals’ widespread noncompliance with the price transparency rule and featuring these recommendations to unleash real prices and usher in a functional, competitive healthcare marketplace:
For a vision of this future, consider existing price transparent providers such as the Surgery Center of Oklahoma, which publishes its complete prices online in a consumer-friendly interface. Their prices are mere fractions of what major hospitals charge for the same services, and patients and employers are saving 30 to 50 percent on their healthcare costs by contracting with them.
For instance, the Surgery Center charges $15,500 for a total knee replacement, one-quarter of the $61,585 cost at a hospital in nearby Dallas. A Georgia woman was able to get her local hospital, which had quoted her $40,000 for a procedure, to match the Surgery Center's $3,600 rate, indicating how a transparent, competitive marketplace based on consumer choice will put healthcare costs in reverse.
Read the full op-ed in RealClearHealth HERE.