The latest release of CMS charges and payments—this time for hospital outpatient services—drew renewed scorn last week from hospital officials, who continue to question the relevance of list prices that the vast majority of patients never see and payers never pay. But like much of the information being released through the Obama administration's healthcare transparency initiative, the wide disparities in outpatient charges likely will be used by insurers and consumer groups to seek a better deal on what they pay.
Why, they might ask, does Medicare receive an average bill for Level 1 ultrasound services of $3,037 from Capital Health Medical Center-Hopewell in Pennington, N.J., while nearby Hunterdon Medical Center in Flemington charges only $482? In central New Jersey, hospitals received an average of about $66 in 2011 for performing the service on Medicare patients.
Hospitals “are going to get a lot more pressure,” said Alyssa Martin, a vice president at William Gallagher Associates, which provides insurance brokerage, risk management and employee benefits services. Of course, the heightened transparency will also challenge payers to increase their own transparency on payments to hospitals and copayments charged to beneficiaries, which could result in their losing negotiating power.