New Trump administration rule will require hospitals to post prices online

Posted on Aug 06, 2018

Under a new Trump administration rule all hospitals will be required to post their charge for surgeries and medical procedures online.

The new rule, completed August 2, 2018 by the Centers for Medicare and Medicaid Services, is part of this administrations goal toward “value based care” which aims to reduce the cost for healthcare. This move by the Trump administration hopes to drive down the cost of healthcare by allowing patients to make informed decisions about different medical procedures and encourage them to shop around.

Until this new ruling, CMS required that hospitals make the information available to anyone who asks for it. This is because there are hundreds of variables to consider when pricing a procedure, facilities and personnel needed, negotiated discounts for carriers and networks, etc. Under the new rule, hospitals will need to update the prices every year beginning Jan. 1, 2019.

“The agency is considering future actions based on the public feedback it received on ways hospitals can display price information that would be most useful to stakeholders and how to create patient-friendly interfaces that allow consumers to more easily access relevant healthcare data and compare providers,” CMS said in a statement.

While this is a step in the right direction that will help expose exaggerated pricing it will probably not be an accurate reflection of what an insured patient would pay.  The posted prices are different than what most patients and health insurance companies pay for care, because each insurer or government payer such as Medicare negotiates payments.  It will be difficult to make this process user-friendly because of the hundreds of variables involved in provider network and government discounts.

An example would be the hospital has a posted price for a patient who walks in the door without insurance and is willing to pay cash for a procedure.  The procedure may be $10,000, but a Physician Provider Organization (PPO) network may have negotiated that $10,000 price down to $3,250, and Medicare may only pay $1,650.  That’s how ridiculous the pricing schemes are today.   This will be a huge project to make it user-friendly and correct to the end user.

If you’re a cash payer it makes a lot of sense, at the very least, to buy into a Physician and Specialist Provider Network Discount Card. It’s not insurance but it allows anyone to take advantage of substantially discounted rates. United Healthcare offers one you can review here:


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