CMS proposal would force hospitals to post negotiated rates

CMS unleashed a slew of proposals July 29, including 2020 payment rule proposals and a requirement for hospitals to publish the payer-specific negotiated prices of healthcare services.

The hospital-focused proposal goes one step beyond a recent executive order from President Trump for hospitals to publish the list prices of healthcare services they provide. According CMS, the actions will better enable patients to shop around for their healthcare services.

“Hospital pricing has been a mystery,” CMS Adminstrator Seema Verma said during a call with reporters Monday.

The proposal falls under the 2020 Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. The proposal would force hospitals to post all prices in a standardized way specific to payers and plans, ensuring patients have the information about their services ahead of time.

“We believe patients deserve to have this information on the front end,” Verma said. “This is about giving patients the information, and they are going to decide how to use it and what works best for them.”

Verma further explained that in every part of the economy, except healthcare, pricing information is available to consumers, and making the information free and accessible will promote market competition and contribute to lower costs. The majority of services that people receive at hospitals, including surgeries, are scheduled ahead of time, meaning the shoppable experience available to patients isn’t necessarily intended for emergency care.

Physician fee schedule 

The 2020 payment proposal also includes several key changes that would reward doctors for the amount of time they spend with patients and for their documentation burdens. Among the changes is a proposal that simplifies coding requirements for evaluation and management (E/M) services. C

However, adjustments to the merit-based incentive payments system (MIPS) have created some concern among industry groups. Specifically, AMGA noted that MIPS may no longer be a “pathway to value” under the 2020 adjustments. By CMS estimates, providers will have the opportunity to earn a 1.4% adjustment in their 2022 payments based on 2020 performance, well below the 9% authorized under MACRA. Because of this reduced adjustment, MIPS may no longer be a viable means to value-based care, AMGA noted.

“We are entering the fourth year of MIPS, and our members expected to have the opportunity to earn a significant payment adjustment if they performed well,” Jerry Penso, MD, MBA, AMGA president and CEO, said in a statement. “By proposing an overly cautious approach, CMS is not rewarding those organizations that made the necessary investments in and championed value-based care as envisioned by congressional leaders.”

See the proposed PFS here.