Innovation Horizons | CMS Hospital Pricing Transparency Requirement
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CMS Hospital Pricing Transparency Requirement

Hospital Transparency

CMS Hospital Pricing Transparency Requirement

As of January 1st, 2021, the Centers for Medicare & Medicaid Services (CMS) requires that all hospitals receiving federal funds comply with the CMS hospital pricing transparency requirement. Hospitals must now post price information on the actual prices negotiated with insurers and the discounts they offer cash-paying customers. At face value, this requirement seems aimed at curtailing prices and better-informing consumers, but some experts are cautious about its actual impact. While each hospital now must post a structured list of the prices for the top 300 procedures, these prices are estimates based on an “average” patient. Additionally, some experts do not think that this pricing transparency will change consumer behaviors, or that many people would look for this data. Price transparency may have the effect of reducing overall healthcare spending by forcing more expensive hospitals to reduce their prices, but the opposite may occur with lower-cost hospitals pushing their prices higher. 

Regardless of the impact, this requirement has been framed as providing data to consumers, but there are many questions about how consumers will access this data, who needs this data the most, and how people will they find it when they need it. There is a need for innovation around patient-centered data distribution that will make it meaningful and actionable for the everyday healthcare consumer.

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