New National Price Transparency Rule and What it means for Marylanders

Key Takeaways:

  • The Federal government recently started to require hospitals across the country to post their charges on their website. But hospitals charges don’t always reflect reality.
  • What insurance companies pay hospitals is a more accurate reflection of health care costs. And, that’s what ‘Wear The Cost’ uses.

 

The Centers for Medicare & Medicaid Services (CMS) have released the 2019 Final Rule for the “Inpatient Prospective Payment System” – the way CMS sets rates with hospitals that participate in Medicare. The new rule also updates CMS policies and includes guidance on price transparency that requires hospitals to post their charges on their websites and update that list at least once a year.

CMS is trying to increase transparency around the cost of health care, and this new rule is a step in the right direction. But, some hospitals and industry groups, are worried that this requirement will cause confusion. And, they have a point: Hospital charges often do not reflect the cost to insurance companies and the ultimate cost to patients. Hospital charges also are tied to billing codes, which can make it hard for patients to decipher.

A more accurate measure is what your health insurance company actually pays. The good news for Marylanders is that we already have claims-level data – thanks to State law. That means Marylanders can see how much health insurance companies paid the hospital on average.

Even better news, Maryland consumers can use the tools provided by ‘Wear The Cost’ to help determine the total cost of certain common inpatient procedures, like a hip or knee replacement, hysterectomy or vaginal delivery. The data on our site is pulled from the insurance claims and could help you estimate the portion of the costs that your insurance company might pass onto you – based on your plan’s deductible and/or co-pays.

We also include the costs associated with all the services you’d receive before and after the procedure – from diagnostic tests to rehabilitation. We have four common episodes of care now and more coming soon.

The health care system in the U.S. is complicated. But, patients deserve to understand the costs associated with their care. We’re here to help!