CMS Proposes Crackdown On Hospitals Violating Price Transparency Rule

Price Transparency Rule

The Centers for Medicare & Medicaid Services seeks to impose penalties on the hospitals. That fails to comply with the price transparency requirements. These recommendations are part of the Medicare Hospital Outpatient Prospective Payment System proposed rule for the year 2022. According to the details, issued by the federal agency. CMS has taken this initiative after listening to the concerns of the consumers. That many of the hospitals fail to provide clear, accessible pricing information available online. As they have been required to do since January 1, 2021. So, it will make sure that Americans get complete insights about what hospital charges for the items and services they provide.

Hospitals with a bed count of 30 or fewer will be bound to pay the penalty of $300/day. On the other hand, a penalty of $10/bed/day would be applied to hospitals with a bed count greater than 30. The imposed fine is not supposed to exceed a maximum daily dollar amount of $5,500.As per this proposed approach, for a full calendar year of noncompliance, the minimum total penalty amount would be $109,500 per hospital. And the maximum total penalty would be $2,007,500 per hospital. The basic purpose of his initiative is to make sure that patients must have the complete understanding to make informed decisions. For example, sometimes, the health processes can cause a financial burden on the patients.

So, staying informed about the costs of medical billing services enables consumers to make a decision about whether or not they can afford the services. Failure to be transparent in pricing models can hold patients back from paying their co-pays and deductibles. Which negatively impacts your financial well-being.

The Impact

CMS is proposing these rules in order to tackle the health equity gap, improving emergency care access in underprivileged communities. And more importantly, enabling people to make informed decisions about their health care. In accordance with President Biden’s Competition Executive Order. CMS is intended to take further actions to increase price transparency at the hospitals and other healthcare facilities.

HHS Secretary Xavier Becerra, while talking about the fight against anti-competition practices, made it clear that everyone must have access to health care. He said that today’s proposed rule is just to make hospitals aware that the administration will not tolerate the hidden costs of the treatments, medical care services and procedures. Furthermore, CMS Administrator Chiquita Brooks LaSure shed light on CMS’s initiatives. She said that the federal agency is committed to addressing the constant unfairness in health outcomes in the United States. This proposed rule will help to achieve the goals of reducing care gaps and ensuring access to every American to affordable, quality medical care services.

She further added that: the federal agency is committed to fulfil the patient’s needs and expand access to care, regardless of where they are. More importantly, to assure that consumers stay knowledgeable about the estimated costs related to the care services and patients’ safety as well. The proposed rule includes the following actions:

Access to Emergency Care in Rural Areas

It has been observed that rural communities suffer acute health crises. Such as; shorter life expectancy, higher mortality, and have fewer healthcare providers. Which is leading to the worst health conditions in those areas. In addition to this, the closure of hospitals has deprived the rural community of basic health needs including access to emergency medical care. However, in order to tackle such issues, Congress enacted Section 125 of the Consolidated Appropriations Act of 2021 (CAA). Which establishes a new provider type for Rural Emergency Hospitals (REHs).

REHs will be responsible to provide emergency healthcare services as well as observation care. In this proposed rule, CMS is requesting information to inform the advancement regarding necessities that would apply to Rural Emergency Hospitals (REHs). This new provider designation will apply to items and services furnished on or after January 1, 2023.Moreover, CMS is also seeking feedback on health & safety standards and potential services to be provided by EHRs.

Improving Patient Experience

The Radiation Oncology (RO) Model aims to enhance the quality of care for cancer patients getting radiotherapy and advance toward a streamlined and unsurprising payment system. CMS is proposing changes to the RO Model, which intend to work on the experience of patients getting radiation therapy. While consolidating proof-based best practices to assist medical care providers in improving patient outcomes.

Health Equity

CMS is also seeking recommendations on the ways for comprehensive and actionable reporting on healthcare disparities. Particularly based on the social risk factors, race and ethnicity. It includes soliciting comments on the potential collection of data, analysis and reporting of quality measures/. Results by a variety of demographic data points including, but not limited to, race, Medicare/Medicaid dual-eligible status, disability status, LGBTQ+, and socioeconomic status.

Moreover, to cover up the flaws discovered during the ongoing pandemic. CMS is seeking feedback on how hospitals are offering flexibility to provide mental health services during the COVID-19 public health emergency. Additionally, the federal agency has proposed changes to measure how many front line workers get vaccinated. Regardless of whether they are working in hospital outpatient departments or ASCs. CMS intends to make this information public. That will keep patients informed about how many workers are vaccinated in different health care settings.

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