Hospitals and insurers question legality, need for CMS price transparency rule

by Robert King | 

Hospitals and insurers are making a last-ditch effort to convince the Trump administration to withdraw a proposal requiring facilities to post payer-negotiated rates online.

Numerous comments on the proposal, which were due Friday, say the Centers for Medicare & Medicaid Services (CMS) will not drive down healthcare costs and will be a pricey burden on facilities. The comments also hint at a likely legal battle that will erupt if CMS goes through with the proposal.

The proposal, included in the 2020 hospital payment rule, would require hospitals starting on Jan. 1, 2020, to post payer-negotiated rates for certain shoppable hospital services. The rates must be available online in a searchable format.

Hospital groups highlighted the sheer cost of the proposed requirement, which CMS pegs at $1,000 a year, and the American Hospital Association commented that the requirement would “impose a substantial burden on hospitals without a corresponding benefit for patients.”

The Rural Hospital Coalition, a group of small rural, Medicare dependent and sole community hospitals, commented it was concerned about “the additional cost to comply burden for rural providers.”

The coalition also added that the transparency of payer-negotiated rates could “negatively impact the availability of health insurance in rural areas and would put further financial pressure on rural hospitals that are already financially fragile.”

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