John Nicolaou, healthcare expert at PA Consulting, discusses new price transparency requirements and the impact on healthcare payers and providers.
The article notes that Trump administration put forth two long-anticipated rules that increase price transparency for both hospitals and insurers.
The CMS' hospital price transparency requirements finalize changes that require health systems to make their standard fees available on-demand and online. The "transparency in coverage" proposed rule would require health plans, including employer-based plans and group and individual plans, to inform participants, beneficiaries and enrollees about price and cost-sharing information ahead of time.
The agency hopes increased price transparency will boost competition among hospitals and insurers to drive down healthcare spending.
The final rule on hospital pricing will go into effect Jan. 1, 2021, and CMS is accepting comments on the proposed rule for payers, which would go into effect one year after it's finalized.
Under the hospital price transparency rule, hospitals must publish their standard charges online in a machine-readable format. They will need to create at least 300 "shoppable" services, including 70 selected by the CMS. Under the rule, hospitals would have to disclose the rates they negotiate with third-party payers, which some experts say could be illegal.
John said: "This plan is a major disruptor for the way that the industry works today, but it is clearly driven and supported by public/consumer sentiment. This will inevitably place greater emphasis on reducing utilization of services through improved population health and care management techniques."
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