Spurred by a recent analysis that found many top hospitals provided inconsistent cost-related information, hospitals will now be adopting new, clearer pricing materials. The Centers for Medicare and Medicaid Services (CMS) are now requiring all hospitals to clearly and plainly
describe each service they offer along with the charges associated with each item or procedure. Such figures are intended to serve as a consumer-friendly tool to guide patients in selecting from over 300 non-emergency services that impact their medical care.

Cost-related information for health services is also expected to be far more accessible, as the mandate details that it must be available via a machine-readable document and visual display of services. To further simplify the process, Medicare’s online Care Compare lays out service and cost information for thousands of Medicare-certified hospitals based on geographic location. Information will include statistics on:

  • Gross charges
  • Cash prices (a discounted sum, in many cases)
  • Negotiated charges relevant to each payer
  • Ranges of deidentified negotiated charges, listed in the form of minimum and maximum

CMS is expecting the rollout of this information to be rather quick due to the perceived impact it will have on Americans seeking health care. The mandate was approved January 1, 2021 and CMS has stated they will complete an early-year audit to ensure hospital compliance. Some hospitals are already demonstrating resistance to this new law, yet CMS warns that they are prepared to issue monetary penalties and corrective plans to those who do not take immediate action.

Pricing transparency within the medical field serves the larger purpose of creating more health literate consumers. Through improved knowledge, consumers are given more autonomy over some of the care they receive and can make more well-informed decisions. This will even allow health care proxies and similar figures to better manage the care of someone who is incapacitated.

The impact on the insurance industry is also major, as clear cost information is expected to drive up competition amongst payers who will be vying to get quality care at the lowest cost. By connecting consumers with more economical care, insurance companies will first need to
ensure their provider networks are in good shape. Networks will need to be expansive enough to support subscribers seeking care from far and wide to get the best price possible. Take early steps to fill the gaps in your provider network by reaching out to TOG Network Solutions to schedule a free consultation.