CMS Introduces New Cost Comparison Tool

December 2018 ~

In an effort to improve healthcare price transparency, CMS launched a tool that allows consumers to compare Medicare payments and copayments for certain procedures that are performed in both hospital outpatient departments and ambulatory surgical centers.

The new Procedure Price Lookup tool displays national averages for the amount Medicare pays the hospital or ambulatory surgical center and the national average copayment amount a beneficiary with no Medicare supplemental insurance would pay the provider.

“Working with their clinicians, the Procedure Price Lookup will help patients with Medicare consider potential cost differences when choosing where to have a medical procedure that best meets their needs,” CMS Administrator Seema Verma stated in an official press release.

In a blog post, Verma went on to say, “This Procedure Price Lookup tool is needed because the law requires that Medicare maintain multiple separate payment systems for different types of health care providers, meaning both CMS and patients pay vastly different amounts for the same service, depending on the site of care. This is also a prime example of Medicare’s misaligned financial incentives, under which providers can make more money if they treat patients at one location as opposed to another. For example: a Medicare beneficiary needs knee surgery, and her surgeon offers her the choice to have the surgery in the local hospital’s outpatient department or at an independent surgery center. With this tool, the beneficiary can type in the type of surgery and see an estimate of the difference in out-of-pocket costs between the two settings.”

“Giving patients access to data is just the first step – we also need to drive towards consumer-friend tools presenting information that is both personal and actionable at the time people seek care.” Verma concluded, “We need to meet patients where they are and integrate cost information into their health care decision making, making it easy for patients to analyze cost differences across all care options.”

Source(s): CMS Press Release; CMS Blog; RevCycleIntelligence;