Price transparency is back in the news, as the Centers for Medicare & Medicaid Services (CMS) recently announced changes to its enforcement process for hospital price transparency rules.
Texas Health will not be impacted by enforcement, as we are compliant with federal and state price transparency rules. Compliance certainly wasn’t easy to achieve, and the large data files the legislation requires are far more useful to third parties - like consultants and payors - than healthcare consumers.
As background, under the federal Hospital Price Transparency Rule, effective Jan. 1, 2021, hospitals are required to publicly post a machine readable file detailing standard charges in different categories. The rule also requires hospitals to provide patients with an out-of-pocket cost estimator tool or payor-specific negotiated rates for at least 300 shoppable services.
Compliance was a challenge the first year for many hospitals as resources were stretched responding to the pandemic, but that has since increased greatly. A February 2023 CMS report found that in 2022, 70% of hospitals complied with both components of the rule, up from 27% in 2021.
More transparency about the costs for services helps consumers make informed decisions about their healthcare, and patients should have access to tools to help understand out-of-pocket costs for care.
However, machine readable files are far from consumer-friendly – they’re large data files intended for processing by computer. And everyone’s situation is unique, with out-of-pocket expenses based on a patient’s healthcare plan, benefit coverage, current health year expenditures and clinical needs.
So, yes, healthcare is complex, but estimating costs does not have to be.
At Texas Health, we not only offer a cost estimation tool on our website but also provide every patient access to our financial counselors. We have invested in a team that provides much more personalized assistance and service than any web tool.
Cost can be a deterrent to seeking care, especially during challenging economic times, but the impacts of delaying care or missing diagnostics are far more costly to patients’ health and well-being in the long run. Our hope is that by offering options and dialogue, no one will turn away from seeking the care they need to live their best lives. More information is available here.