The new government price transparency rule makes it a requirement for hospitals to provide clear, accurate price information regarding services and procedures. This way, you can shop around and know what you are paying for!
This blog will answer the question, “What is healthcare transparency?” and give you tools to help you compare hospital pricing and reduce your medical costs. It’s easy to make mistakes when choosing healthcare or when assuming that you don’t have choices to begin with, but we are here to help! It doesn’t have to be an overwhelming, confusing process.
The Centers for Medicare and Medicaid Services, also known as CMS, joined with the Departments of Labor and Treasury under the guidance of President Trump to issue a final rule on healthcare price transparency, making a historic gain for American citizens. CMS has been working on finalizing this rule for the past three years, and it is finally under solid authorization.
Before this historic change, obscure prices for healthcare in America served special interests, big business hospitals, and physicians, while hurting patients and leaving them in the dark. Now, providers, clinics, and hospitals will have to compete not only for fair and equitable prices but for quality of service—which is the way it should be.
As you learn about this government rule, you might be overwhelmed, thinking, “What is price transparency healthcare? What is the CMS price transparency rule?” Don’t worry—we’ve got your answers.
How the CMS Government Price Transparency Rule May Lower Your Healthcare Costs
This finalized government transparency rule comes on the back of other work that the CMS has done over the past few years. Hospitals will now be required to:
- Post standard pricing online and update it every year
- Standardize requirements for all hospitals beginning in 2021
- Offer to lower payments if you were not provided pricing information upfront
- Provide information about all Exchange plans to compare coverage
- Provide you with easy-to-understand, easy-to-navigate, electronic access to all their information so that they can make informed decisions
- Release Transformed Medicaid Statistical Information System data files to stakeholders with information about enrollment, payments, and services provided to Medicaid and Children’s Health Insurance Program (CHIP) patients
The CMS also instituted programs to go along with these requirements.
- The Procedure Price Lookup helps you compare Medicare deductibles and copayments within hospitals, outpatient clinics, and ambulatory surgical centers.
- The Care Compare program provides specialty practice cost estimates for Medicare patients.
- The Medicare Plan Finder allows you to compare Medicare Advantage and Part D plans to learn about extra benefits.
- Blue Button 2.0 makes it easy to sync up health apps and organize data for claims, health plan coverage, appointments, and symptoms.
- The Medicaid and CHIP Scorecard allows for transparent opinions on how well beneficiaries felt they were served so that you can choose a provider who treats their patients how you want to be treated.
- The Provider Data Catalog allows information about provider resources, prices, and services to be downloaded and accessed easily.
What Is the CMS Price Transparency Rule?
This government price transparency rule will take effect on January 1, 2023.
This government price transparency rule means that everyone choosing healthcare should know upfront exactly how much their healthcare plan will cost and what it will cover. This will hopefully allow people to make fully informed decisions that align not only with their budgets, but their beliefs.
Under this order, private health plans, such as group health and individual health insurance programs, must have clear and accurate information regarding premiums, co-pays, and cost-sharing guidelines available for people to compare before choosing a plan. This allows patients to plan for their out-of-pocket costs.
This rule helps people understand exactly what they are paying for. This transparent information will also allow technology companies to create price comparison tools that will encourage companies to keep prices low in order to compete in the marketplace..
Even if the price comparison tools might not be exact, they will give patients a solid idea of the range that they can expect to have to pay out of pocket for any service, procedure, or appointment.
Why You Want to Compare Hospital Prices
Under this new rule, health plans will have an online tool where patients can essentially “shop around” for the best prices and choices of where they would like to have procedures. This online estimate will be available for 500 of the most common procedures, with most others following close behind in January of 2024. This second-year update will also include prescription drugs and medical equipment in the cost estimates.
This price transparency rule doesn’t mean that every hospital or provider will charge the same amount for the same service. That’s why it’s so important to be able to shop around and compare not only prices but customer experiences, like those shown on the Medicaid and CHIP Scorecard.
Under this new healthcare requirement, you will be able to compare Colorado hospitals for many of the procedures that you know you’ll need to schedule in the future. Although plenty of hospital services are emergent or come without time to plan, you will be able to use this foundational knowledge to make an informed, “quick” decision if something comes up and you need to act fast.
When comparing Colorado hospital prices, use the hospital website to access pricing information. Utilize the other CMS programs, such as Procedure Price Lookup, Care Compare, and Blue Button 2.0 to shop, compare, and retain user-friendly access to information about all your healthcare conditions, appointments, services, etc. This will create a full, clear picture of your options, your past payments, and your future available choices.
Will This Rule Lower Healthcare Pricing?
After taking in all this information, the question remains: How will price transparency change healthcare? Well, some people say that it might be the biggest gain toward providing the public with true, accurate information about health care costs.
The implementation of this rule will hopefully make the United States healthcare healthcare system more efficient for its patients. American citizens deserve to know how much they will be paying for a service before going forward, and they deserve to have choices about where they put their money (and their trust). When prices are out there for all to see, it also encourages providers and hospitals to lower their prices to a more competitive rate.
Citizens have demanded the answers and now the government price transparency rule is beginning to make them available.
They also understand that just because something costs more money, that doesn’t necessarily mean that it’s better. Patients want to know that they will be treated fairly, listened to, and taken care of with a high level of compassion and individual attention.
Usually, people who begin comparing prices continue to do so. Knowledge is power, and you deserve to have choice and freedom over your health.
In the past decade, healthcare premiums have gone up almost 70%! This is an astronomical amount—you deserve to not only know what you’re paying for but to have access to a healthcare system with fair prices that don’t rise each year without justifiable cause.
It might feel strange to fight for your consumer rights when it comes to healthcare. Our society has made citizens feel as if they don’t have choices or options when it comes to their health, and that they simply have to take what is offered to them. This government transparency rule is about bringing that idea to an about-face, making it easy for you to stand up as the customer and demand access to information.
Wiley Long is the president of ColoHealth, and has been in the health insurance industry since 1987. He received his master’s degree in nutrition and exercise science at Colorado State University, and is passionate about individual healthcare freedom. Read more about Wiley on his Bio page.