Healthcare News & Insights

CMS makes hospital billing data public online

A recent decision by the Centers for Medicare & Medicaid Services (CMS) means that competing hospitals will now be able to see what your hospital charges for various procedures – and patients will, as well.

80377479For years, CMS has maintained a database of info about the prices hospitals around the country have billed for procedures. But the info wasn’t easily accessible until now.

Now, in the interest of transparency, CMS has decided to publicly publish the prices hospitals charge via the Medicare Provider Charge Data page on its website. The data includes hospital-specific charges for thousands of hospitals that receive reimbursement from Medicare. Info is listed for the 100 most frequently billed discharges and their associated costs.

Instead of showing data for the rates Medicare negotiates with hospitals, CMS is showing actual list prices for the procedures.

The numbers show sharp differences in raw pricing depending upon where patients seek care.

For example, regarding joint replacements, the most common procedure that Medicare patients receive, prices ranged from $5,304 in Ada, OK, to $223,373 in Monterey, CA, according to the Washington Post. The average price across the country was $53,063.

The article goes on to list six states that typically had higher prices than most for hospital procedures: California, Florida, Nevada, New Jersey, Pennsylvania and Texas.

Potential changes to the healthcare landscape

What this means in a nutshell: Hospitals will be more accountable for the prices they set.

So it’ll be more important to know pricing trends for various procedures in your area. As the feds push to cut healthcare spending, any hospitals seen as outliers will be in their crosshairs.

You don’t want your costs to stand out from the norm without a compelling reason. Although there’s room for variation, too much in either direction will likely be a red flag.

You’ll also have to be ready to explain costs to patients, particularly those who self pay – or be prepared to lose them to the hospital down the road. Telling patients that hospitals rarely bill patients the full list charge is a good start.

However, if you can go further and offer them a clear reason why your costs are more or less expensive than other hospitals (i.e., better technology or more advanced treatment options), they’ll be more likely to see the value in your rates.

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