CMS Administrator Seema Verma calls on hospitals to go beyond price transparency requirements

Friday, January 11, 2019

CMS Administrator Seema Verma urged hospitals to go above and beyond the price transparency requirements laid out in the 2019 IPPS final rule. The requirement that hospitals post a list of their standard charges online in a machine-readable format went into effect January 1.

During a press call, Verma named the three systems—UCHealth in Colorado, Mayo Clinic in Minnesota, and University of Utah Health—as exemplars, urging other hospitals to similarly go above and beyond the requirements laid out in revised price-transparency guidelines that took effect this month.

Every hospital in the U.S. is now required to publish a standard list of prices online in a machine-readable format. Even when hospitals publish their chargemasters as required, however, patients may have a tough time finding them, and they are likely to struggle in deciphering the document's medical jargon, acronyms, and atomized list of codes.

That's not to say the new policy isn't working. By requiring the data to be machine-readable, CMS opened a door for problem-solvers to help aggregate and interpret the information to empower consumer decision-making, Verma said.

"Our initiative was really a first step," she said, adding that provider organizations and third parties alike can and should build upon that foundation.

UCHealth launched its own custom solution last year that offers individualized price estimates through a patient portal and mobile app for five of its 10 hospitals (with more locations to be added at the end of this quarter).

The platform considers an individual patient's health plan to calculate an estimated price breakdown with expected out-of-pocket costs for more than 150 services, UCHealth spokesperson Dan Weaver tells HealthLeaders. For patients with follow-up questions or inquiries about prices for services not on the list, UCHealth complemented its digital platform with a dedicated hotline.

The project has been in development about 18 months, since UCHealth President and CEO Elizabeth B. Concordia pushed to make cost estimates easier and more accurate in response to consumer demand, Weaver says.

"As high-deductible insurance plans have become more common over the last decade, we've seen more and more patients asking providers for these estimates," he adds.

Since its soft-launch late last summer, the UCHealth platform has been updated with patient-friendly language to replace the ICD-10 codes, acronyms, and abbreviations that make the raw chargemaster incomprehensible to most consumers, Weaver says. The platform has been processing about 400 estimates per week.

Mayo Clinic Chief Financial Officer Dennis Dahlen says the chargemaster disclosure requirement is one way to boost transparency, though patients need more information to be empowered as consumers.

"Cost and price information should be based on information that allows patients to meaningfully differentiate among providers in choosing the care that is best for themselves and their families," Dahlen says in a statement emailed to HealthLeaders. "Cost information therefore must be presented in the context of quality and outcomes for patients to make choices that best meet their personal goals."

Mayo Clinic has operated an online cost estimator for about four years, a spokesperson says.

There are currently no penalties for hospitals that fail to comply with the requirement to publish their chargemasters, but CMS is considering feedback on a request for information that could lead to tweaks and teeth in future iterations of the policy.

But providers shouldn't sit on their hands, Verma said.

"Hospitals don't have to wait for us to go further in helping their patients understand what care will cost," she said.

Editor's note: This article was originally published on HealthLeaders Media.