CMS Releases Charges For Outpatient Hospital Procedures

Posted on by Frank J. Rosello

Less than a month after the CMS released data on what hospitals charge for inpatient procedures, the agency has released similar information about the prices hospitals submit and are paid on the outpatient side.

The greater transparency comes as hospitals have pushed back against the initiative, arguing that the data isn’t meaningful to consumers because of the gulf between what hospitals charge and the bottom line for patients.

HHS Secretary Kathleen Sebelius unveiled the calendar year 2011 data on Monday, June 3rd as part of Health Datapalooza IV, an annual conference on data transparency. In addition to the pricing information for 30 hospital outpatient procedures, the CMS released county-level data on Medicare expenditures and the different brands of electronic health records being adopted.

Click here to view CMS 2011 charge data.

As with inpatient services, hospital charges ran the gamut. For instance, Fort Walton Medical Center, Pensacola, Fla., charged $32,105.64 in 2011 for a level IV upper airway endoscopy. The 257-bed hospital, part of publicly traded HCA, was reimbursed an average of $1,396.45.

Yet for the same procedure, 98-bed Park Ridge Health, Hendersonville, N.C., part of Adventist Health System, charged $1,527.95 and was reimbursed $884.10.

HCA’s Fawcett Memorial Hospital, a 238-bed facility in Port Charlotte, Fla., charged $13,984.79 for a level III ultrasound without contrast, and was reimbursed an average of $536.32. At 135-bed Logan (Utah) Regional Hospital, part of Intermountain Healthcare, the list price for the procedure is $678.24, and it was reimbursed $521.60.

Chip Kahn, president and CEO of the Federation of American Hospitals, which represents for-profit systems, said in a statement that the latest data release “again misses the mark in providing price transparency to help consumers.”

Consumers, he added, need information that helps them make better decisions, “which in most cases will be what it costs them out of pocket for their care. That is why we believe that insurers should be required to provide to their members meaningful cost-sharing information enabling them to make good healthcare choices.”

A report last month from Moody’s also noted that data doesn’t allow consumers to do true comparison shopping—although price transparency could one day be a marketing strategy for some hospitals.

The greater risk, the report said, is that persistent pricing disparities will invite greater scrutiny and regulation, which could require even more disclosures from hospitals and force them to rationalize the prices they charge.

Fred Entin, who specializes in corporate compliance and healthcare regulatory issues at law firm Polsinelli, agreed that hospitals may be compelled to adjust their prices.

But in the near-term, he said, the data is likely to be most useful at present to people involved in setting up health insurance exchanges or shared-savings programs, such as accountable care organizations.

“It’s probably too early to really know what the impact is,” he said, “but the fact that this information is out there is probably going to drive more changes in how procedures are priced, how they’re paid for and how decisions are made.”

Article written by Beth Kutscher



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