National hospital groups: OPPS price transparency proposal is ‘misguided’

August 12, 2019
Medicare Web

The American Hospital Association (AHA) and several other hospital groups released a joint statement criticizing CMS’ proposed price transparency policy outlined in the calendar year (CY) 2020 OPPS proposed rule that would require hospitals to publish negotiated rates with private payers.

In the CY 2020 OPPS proposed rule released July 29, CMS proposed that effective January 1, 2020, hospitals would be required to make publicly available their standard charges, which it defines as the gross price of all services provided by a hospital as well as payer-specific negotiated prices. These charges would be posted on the internet in a machine-readable format that includes information such as common billing or accounting codes used by the hospital and a description of items or services. According to CMS, this would provide patients with a common framework for comparing standard charges between hospitals.

If finalized, the price transparency policy would also require hospitals to make public "consumer friendly," payer-specific negotiated charges for common shoppable services, such as imaging, outpatient visits, laboratory tests, and bundled services such as cesarean delivery. 

The same day CMS released the proposed rule, the AHA, America’s Essential Hospitals, the Association of American Medical Colleges, the Children’s Hospital Association, and the Federation of American Hospitals issued a joint statement urging against implementation of the price transparency proposals. In their statement, the groups write that the proposal is a “misguided attempt to improve price transparency” because it would fail to give patients the information they need. Specifically, the hospitals groups write that the disclosure of negotiated rates between insurers and hospitals would not help patients make informed decisions about their care and could harm patients by reducing their access to care.

In a separate statement released by the AHA, president and CEO Rick Pollack argues that the policy could limit choices available to patients in the private market and encourage anticompetitive behavior among commercial health insurers. According to Pollack, the proposed policy should be abandoned.

Additional information on stakeholder reactions to the price transparency proposal and other OPPS proposals can be found here.

More detailed information on the price transparency policy and other OPPS proposals can be found in CMS’ fact sheet. Stakeholders can comment on 2020 OPPS proposals until September 27.