Medicare’s Verma promises more healthcare price transparency
Skip to main content
MDHC_Logotype_white
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • This Week's News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • MedPAC likely to recommend CMS simplify alternative payment models
      Medicare physician claims down 19% in first half of 2020 from pre-pandemic expectations
      Florida governor faces growing charges of vaccine favoritism
      Insurance regulator to issue warning on virus-test billing
    • Florida governor faces growing charges of vaccine favoritism
      Insurance regulator to issue warning on virus-test billing
      Sutter Health posts sizable 2020 loss, announces sweeping review of finances
      Accidentally trashed, thawed or expired: Reports of COVID vaccine spoilage
    • Shareholder group calls out HCA for alleged excessive emergency department admissions
      Metrologo 600x400_i.jpg
      MetroHealth forms Center for Cancer Research
      The Check Up: Dr. Marc Boom
      The Check Up: Dr. Marc Boom of Houston Methodist
      Dr. Marc Boom
      Q&A: Houston Methodist CEO praises staff efforts to keep vaccine efforts going during ice storm
    • Solid sign-ups for Biden's new Obamacare coverage offer
      OU Health Physicians, Oklahoma Blues plan fail to reach new contract
      Blue Cross NC claims costs rise thanks to COVID
      BlueCrossBlueShieldSign-main_i_i_i.jpg
      Michigan Blues post lowest operating profits in four years amid COVID-19 pandemic
    • MedPAC likely to recommend CMS simplify alternative payment models
      Florida governor faces growing charges of vaccine favoritism
      States rapidly expanding vaccine access as supplies surge
      Becerra taking heat for support of abortion rights
    • Sutter Health posts sizable 2020 loss, announces sweeping review of finances
      UPMC's patient volumes stabilize, boosting 2020 profits
      Genomics firms taking advantage of SPACs trend to go public faster
      COVID-19 could dent hospital revenue by at least $53 billion in 2021, AHA says
    • Insurance regulator to issue warning on virus-test billing
      351532635.jpg
      Red-hot virtual care market propels New York City health startups to record year
      Teladoc reports $383.3M in fourth-quarter revenue, up 145%
      man and woman looking at ipad wearing face masks stock image
      Sponsored Content Provided By Surescripts
      Improvements to benefits data can enhance ePrescribing and the patient experience
    • Accidentally trashed, thawed or expired: Reports of COVID vaccine spoilage
      Coronavirus deranges the immune system in complex and deadly ways
      Majority of small businesses not requiring vaccines, tests
      Highmark Health partners with Verily subsidiary on chronic care issues
    • Francoise_Adan1_i.jpg
      Cleveland's UH creates position of chief whole health and well-being officer
      Alicia Wilson
      Q&A: Emerging leader Alicia Wilson on staying close to home
      Michael Jordan, Novant team up to address health equity
      Former Ascension CEO, the first to lead the health system, passes away
    • Midwest
    • Northeast
    • South
    • West
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
    • The Affordable Care Act after 10 years
    • Dr. John Fischer
      Patient-reported outcomes tool for hernia surgery helps physicians improve care
      New care model helps primary-care practices treat obesity
      doctor with patient
      COVID-19 treatment protocol developed in the field helps patients recover
      Rachel Wyatt
      Project to curb pressure injuries in hospitals shows promise
    • What's next for on-demand telehealth companies?
      A CalOptima PACE vaccination clinic.
      Will COVID-19 be the catalyst for creating a more sustainable healthcare system?
      A map of the U.S. with images of the coronavirus.
      The digital divide becomes a new social determinant of health
      Ascension’s St. Mary’s Hospital Surgery Center at Towne Centre and Allegheny Health Network’s Bethel Park surgery center
      Hospitals see opportunity, risk in ambulatory surgery centers
    • Dr. Daniel Hall
      UPMC pilots machine learning, telehealth to inform patient transfers
      A woman being recorded using her inhaler on a smartphone.
      Digital check-ins, connected inhalers help control asthma
      A phone screen showing the question, "Mary we hope this information was helpful and we'd like to keep guiding you. Are you interested in knowing when it's your turn to receive the vaccine?"
      Chatbots, texting campaigns help manage influx of COVID vax questions
      A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • What's next for on-demand telehealth companies?
      Rising prescription copays drop adherence, spike mortality, research shows
      Dr. John Fischer
      Patient-reported outcomes tool for hernia surgery helps physicians improve care
      Highmark Health inks six-year cloud, tech deal with Google
    • Hospitals' Medicare billing practices suggest upcoding, OIG says
      California hospitals prepare ethical protocol to prioritize lifesaving care
      Amazon, JPMorgan Chase, Berkshire Hathaway disband Haven
      Digital pathways poised to reshape healthcare continuum in 2021
    • Dr. Daniel Hall
      UPMC pilots machine learning, telehealth to inform patient transfers
      A woman being recorded using her inhaler on a smartphone.
      Digital check-ins, connected inhalers help control asthma
      Humana partners with in-home provider for 24/7 care
      A phone screen showing the question, "Mary we hope this information was helpful and we'd like to keep guiding you. Are you interested in knowing when it's your turn to receive the vaccine?"
      Chatbots, texting campaigns help manage influx of COVID vax questions
    • MedPAC likely to recommend CMS simplify alternative payment models
      Bundled payments reduce surgery costs by 10.7%
      Coordinated payment policies could speed transition to value, experts say
      CMMI's geographic direct contracting model needs an overhaul, experts say
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
    • Health Systems Financials
      Executive Compensation
      Physician Compensation
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Dr. Alan Kaplan
      The risks, rewards of taking organizations 'where they haven’t gone before'
      Wellstar CEO calls adapting for the pandemic her bold move
      Howard P. Kern
      Recognizing the value of telehealth in its infancy
      Dr. Stephen Markovich
      A bold move helped take him from family doctor to OhioHealth CEO
    • Dr. Stephen Markovich
      Making sure we're aligned along the path to achieving inclusion
      Barry Ostrowsky
      Ending racism is a journey taken together; the starting point must be now
      Laura Lee Hall and Gary Puckrein
      Increased flu vaccination has never been more important for communities of color
      John Daniels Jr.
      Health equity: Making the journey from buzzword to reality
    • Vaccinating children could be the key to ending the pandemic
      Mikelle Moore
      The promising future of rural healthcare, even amid the COVID-19 pandemic
      In-person visitation must be part of the national COVID-19 response
      We've lost so much to the pandemic, but we've also made gains that will endure
    • Letters: Eliminating bias in healthcare needs to be ‘deliberate and organic’
      Letters: Maybe dropping out of ACOs is a good thing for patients
      Letters: White House and Congress share blame for lack of national COVID strategy
      Letters: VA making strides to improve state veterans home inspections
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Award Programs
    • Nominate
    • Previous Award Programs
    • Other Award Programs
    • Best Places to Work in Healthcare Logo for Navigation
      Nominations Open - Best Places to Work in Healthcare
      Nominations Open - 50 Most Influential Clinical Executives
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Minorities in Healthcare
      • - Luminaries
      • - Top 25 Minority Leaders
      • - Minorities to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • COVID-19 Event Tracker
    • podium march webinar logo lockup
      Sponsored Content Provided By Podium
      Webinar: Critical Touchpoints for Every Patient’s Journey — How Technology Plays an Important Role
      scp health logo lockup march 2021
      Sponsored Content Provided By SCP Health
      Webinar: COVID’s call to action — Reset for success in 2021
    • Women Leaders in Healthcare Conference
    • Social Determinants of Health Symposium
    • Healthcare Transformation Summit
    • Leadership Symposium
    • Virtual Briefings
      • - Hospital of the Future
      • - Mental Health
      • - Patient Safety & Quality
      • - Strategic Marketing
      • - Virtual Health
      • - Workplace of the Future
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Minority Leaders Gala
    • Top 25 Women Leaders Gala
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
    • Next Up Podcast: Educating patients on the COVID-19 vaccine with Tanya Andreadis
      Dr. Joseph Cacchione
      Next Up Podcast: Educating patients on the COVID-19 vaccine with Dr. Joseph Cacchione
      Dr. Karen DeSalvo
      Next Up Podcast: What to expect with telehealth and healthcare technology in the next four years
      Carter Dredge
      Next Up Podcast: Ready, set, innovate! Innovation and disruption in healthcare
    • Beyond the Byline: Insurers are betting on virtual-first plans as COVID-19 shifts care pathways
      Beyond the Byline: How residents' stories shape our coverage of the vaccination rollout in nursing homes
      Beyond the Byline: Regulators aim to boost value push with fraud and abuse law updates
      An older man wearing a mask receiving a vaccine.
      Beyond the Byline: Verifying information on the chaotic COVID-19 vaccine rollout
    • Outreach during COVID-19
      Leading intention promote diversity and inclusion
      Introducing Healthcare Insider Podcast
    • The Check Up: Dr. Marc Boom
      The Check Up: Dr. Marc Boom of Houston Methodist
      The Check Up: Dr. Imran Andrabi
      The Check Up: Dr. Imran Andrabi of ThedaCare
      The Check Up: Tanya Blackmon
      The Check Up: Tanya Blackmon of Novant Health
      The Check Up: Dr. Patrick Hwu
      The Check Up: Dr. Patrick Hwu of the Moffitt Cancer Center
    • ivana naeymi-rad one on one intelligent medical objects
      Video: Ivana Naeymi Rad of Intelligent Medical Objects
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Law & Regulation
August 03, 2019 01:00 AM

Medicare’s Verma promises more healthcare price transparency

Maria Castellucci
Shelby Livingston
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print
    CMS Administrator Seema Verma
    Ryan Lewis

    “Not everyone is going to shop around … but some people will and that is probably enough for the market to move.”

    Seema Verma
    CMS administrator

    CMS Administrator Seema Verma made it clear last week: The agency is not done pushing policies aimed at giving patients greater access to information about the cost of their care.

    “There will be more to come on price transparency … this is a large problem for the entire healthcare system,” Verma said last week at Modern Healthcare’s Women Leaders in Healthcare Conference in Chicago.

    That won’t sit well with healthcare lobbyists who assaulted the agency’s most recent transparency pitch—that hospitals be forced to publicly post both their gross and insurer-negotiated prices.

    While the hospital and insurer industries argued strongly that the CMS proposal wouldn’t bend the cost curve and may even harm patients, Verma said the criticisms are from stakeholders intent upon maintaining the status quo and the requirement could actually make a meaningful difference.

    The idea, wrapped into the broader outpatient prospective payment system proposed rule, would force hospitals by January 2020 to post online the negotiated price by specific payer and plan for “shoppable services.” That includes procedures patients can book in advance, such as X-rays, outpatient visits and lab tests as well as bundled services like a cesarean delivery. Already hospitals are mandated to post their chargemaster prices, which most experts say has been largely ineffective because patients rarely pay those rates. Verma seemed to acknowledge as much.

    That rule, she said, is only helpful to the uninsured, but “if you had insurance, it didn’t provide you with the information you need.” Further, accessing the information is likely confusing for consumers because the rule didn’t specify how hospitals must display that information to patients.

    This new proposal “is more streamlined,” she added.

    Critics of the agency’s approach contend that patients don’t need to see negotiated rates. What they want is information about their out-of-pocket costs, which some hospitals are already providing via online cost transparency tools. Hospital and insurer lobbying groups—who are expected to sue to stop the requirement—warned that exposing the rates could undermine their ability to negotiate with each other.

    Evidence has shown that many people don’t shop for healthcare, often because they have trouble finding price information, according to Dr. Ateev Mehrotra, an associate professor at Harvard Medical School who has studied price transparency. He agreed with the hospitals that patients care about out-of-pocket costs, not negotiated rates.

    “Not everyone is going to shop around … but some people will and that is probably enough for the market to move,” Verma countered. “That is enough for (hospitals) to say, ‘I may want to lower my price to attract more patients.’ It only takes a few people to actually move the market.”

    How quickly that may happen is up for debate.

    “It’s going to be nearly impossible for hospitals to comply with this even if there are stiff penalties,” said Paul Shorrosh, CEO of revenue-cycle vendor AccuReg, which has created price-estimator tools for hospitals like Mosaic Life Care. “Each of those (insurance) contracts has multiple payment methodologies depending on whether it’s inpatient or outpatient. The only way to do that is computerize it. There’s no other way. If they publish contracted rates, it’s not going to make sense to anybody.”

    But most hospital cost-estimator tools don’t show what patients would pay by going to a competitor down the road. Enabling patients to make an apples-to-apples comparison between providers is exactly what the CMS hopes posting the negotiated rates will allow.

    Just getting the secret data out in the open and allowing researchers and policy experts to harness it could help lawmakers create better policy, said Benedic Ippolito, an economist with the American Enterprise Institute. “Tomorrow it may not be the most useful data, but who knows in 10 years,” he said.

    Ippolito also doubted that exposing negotiated rates could lead some lower-cost healthcare providers to raise prices to meet those of higher-cost competitors, as some observers predicted. That’s because most hospitals in any given market already have a pretty good idea of others’ prices, he said.

    Bob Berenson, a healthcare policy expert at the Urban Institute think tank, along with several other sources, said the proposal could lead to lower prices if the public or policymakers use the price information to shame high-cost hospitals into bringing their prices down.

    With healthcare spending climbing higher, Berenson said he doesn’t see many other options beyond transparency and price controls.

    “I don’t see alternatives,” he said. “We have rates going through the roof.”

    RELATED STORY: Medicare proposes range of pay cuts, increases for outpatient services

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Info-blocking regs to force ‘culture change,' says new ONC chief Tripathi
    Info-blocking regs to force ‘culture change,' says new ONC chief Tripathi
    Hospitals ask Supreme Court to toss 340B, site-neutral pay cuts
    Hospitals ask Supreme Court to toss 340B, site-neutral pay cuts
    Sponsored Content
    Get Free Newsletters

    Sign up for free enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today

    The weekly magazine, websites, research and databases provide a powerful and all-encompassing industry presence. We help you make informed business decisions and lead your organizations to success.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Stay Connected

    Join the conversation with Modern Healthcare through our social media pages

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2021. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Minorities in Healthcare
          • - Luminaries
          • - Top 25 Minority Leaders
          • - Minorities to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Nominate
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Women Leaders in Healthcare Conference
        • Social Determinants of Health Symposium
        • Healthcare Transformation Summit
        • Leadership Symposium
        • Virtual Briefings
          • - Hospital of the Future
          • - Mental Health
          • - Patient Safety & Quality
          • - Strategic Marketing
          • - Virtual Health
          • - Workplace of the Future
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Minority Leaders Gala
        • Top 25 Women Leaders Gala
      • Webinars
      • COVID-19 Event Tracker
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing