The Centers for Medicare and Medicaid Services finalized a rule on Thursday, requiring private payers to disclose negotiated rates for imaging and other services.
All told, the initial list covers 500 “shoppable services,” running from CT scans of the head and brain, down to foot and ankle x-rays. The administration said its goal is to compel consumers to seek out the best deals for their treatment.
“Hidden healthcare prices have produced a dysfunctional system that serves special interests but leaves patients out in the cold,” CMS Administrator Seema Verma said Thursday. “Price transparency puts patients in control and supports competition on the basis of cost and quality which can rein in the high cost of care.”
The rule pertains to most group health plans—along with insurance issuers in the group and individual markets—covering about 200 million Americans. It stipulates that insurers must provide easy-t0-understand info on enrollee cost-sharing, along with the rates they’re actually paying to radiologists and other providers for services. Beginning Jan. 1, 2023, they must offer an online shopping tool allowing patients to see the negotiated rate, along with a personalized estimate of out-of-pocket costs for those 500 shoppable services. By the start of 2024, CMS will require pricing for all remaining procedures, along with drugs and durable medical equipment.
The agency is also doing the same with a separate rule for hospitals that starts Jan. 1, which the American Hospital Association is currently fighting in court.
America’s Health Insurance Plans blasted the final rule on Thursday, claiming it will lead to costlier care for consumers. It noted that 75% of commercial insurers already provide price transparency tools to more than 120 million beneficiaries and divulging these amounts will have the opposite intended effect.
“Competition experts, including the bipartisan Federal Trade Commission, agree that disclosing privately negotiated rates will reduce incentives to offer lower rates, creating a floor—not a ceiling—for the prices that drugmakers, providers and device makers would be willing to accept,” Matt Eyles, president and CEO of the insurance lobbying group, said in a statement.
You can read more about the “Transparency in Coverage” rule in this CMS fact sheet, or check out the entire 556-page legislation here. The list of shoppable services starts on page 93.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.