CMS Launches Online Tool to Empower Medicare Beneficiaries with Transparent Surgical Procedure Pricing

Recently, VCBeat (WeChat Official Account: vcbeat) learned from foreign media reports that the U.S. Centers for Medicare & Medicaid Services (CMS) announced on November 27 local time the launch of a new online digital tool, “Procedure Price Lookup,” designed to enable Medicare beneficiaries to more conveniently and quickly look up surgical prices and out-of-pocket costs.

This new procedure price lookup tool is a website that allows Medicare beneficiaries to query the national average costs for certain procedures paid by Medicare to hospitals or ambulatory surgical centers, and to compare their Medicare payments and copayments. The website also displays the national average out-of-pocket costs, which represent the national average amount that beneficiaries without supplemental Medicare insurance should pay to providers.

Price Comparison Between Ambulatory Surgery Centers and Hospital Outpatient Departments Queried on This Website

“It’s like going to the grocery store to buy your weekly groceries, but not knowing the prices of the items you purchased until you receive the bill from the store a week later. Sadly, this is how healthcare currently works,” said Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS), in a statement. “Price transparency in healthcare is a top priority for the Trump administration. When choosing medical procedures that best meet the needs of Medicare beneficiaries, the procedure price lookup tool will help them take potential cost differences into account.”

Seema Verma was announced as the 15th Administrator of the Centers for Medicare & Medicaid Services (CMS) in March 2017. She has amassed extensive experience in healthcare policy, Medicaid, insurance, and public health, with a commitment to empowering patients to take ownership of their healthcare and ensuring their access to high-quality healthcare resources. She collaborates with U.S. states to provide them with flexible Medicaid programs, helping them meet the diverse needs of consumers. Since assuming her role at CMS, Seema Verma has aimed to reduce burdensome regulations, enabling physicians and healthcare providers to focus on delivering high-quality medical care to patients.

The Procedure Price Lookup Tool was launched in response to the mandate from the U.S. Congress under the 21st Century Cures Act. Medicare regulations require the Centers for Medicare & Medicaid Services (CMS) to maintain separate payment systems for different types of healthcare providers. This means that CMS and patients may pay different amounts for the same service, depending on the place of service.

According to "21st Century Cures Act," CMS created a Procedure Price Lookup tool that will help Medicare beneficiaries compare surgical costs among different healthcare providers. For example, patients requiring knee surgery can use the website to find cash price estimates for local hospital outpatient departments and independent ambulatory surgical centers to determine their final treatment plan.

Seema Verma stated, “Differing payment rates are a prime example of the misaligned financial incentives in Medicare. Under this incentive structure, providers can earn more money depending on the site of care.”

Established in 1977 and headquartered in Woodlawn, Maryland, the Centers for Medicare & Medicaid Services (CMS) is a federal agency within the U.S. Department of Health and Human Services. It provides policy and technical guidance for the planning, development, administration, and evaluation of healthcare financing programs. The agency is responsible for administering the Medicare and Medicaid programs, establishing quality standards for long-term care facilities, and overseeing process certification.

Image from the CMS official website

CMS recently launched the eMedicare program, designed to provide Medicare beneficiaries with cost and quality information. The program introduced an interactive online decision support tool to help individuals better understand and evaluate their Medicare coverage options. Additionally, eMedicare offers a mobile-optimized out-of-pocket cost calculator that provides Medicare beneficiaries with information on overall plan costs and prescription drug expenses.

The procedure price lookup tool recently launched by the Centers for Medicare & Medicaid Services (CMS) is part of the agency’s eMedicare initiative. CMS has also introduced additional patient-facing transparency tools that identify prescription drug manufacturers responsible for price increases, including details on the agency’s drug pricing and expenditures, thereby providing patients with more comprehensive information on Medicare and Medicaid spending related to medications than ever before.

The Centers for Medicare & Medicaid Services (CMS) is driving greater transparency in hospital charges for patients, extending beyond surgical fees alone. The agency has updated its prior price transparency guidelines. These guidelines, derived from the Affordable Care Act, require hospitals to publish standard charge lists in an online, machine-readable format starting January 1, 2019, and to update their charge information and retail price lists at least annually.

The American Hospital Association and other stakeholders have begun to oppose the Centers for Medicare & Medicaid Services’ (CMS) efforts regarding price transparency. They argue that payers should serve as the primary source of information on prices and out-of-pocket costs. They further contend that providers’ charge and payment data are proprietary and of little utility to consumers, who are primarily concerned only with their own financial liability.