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Price transparency in the spotlight: Patient demand grows for accurate healthcare service costs

March 20, 2023
Business Affairs
Christine Cooper
By Christine Cooper

As healthcare costs continue to rise with inflation, a patient’s need for easy and immediate access to accurate pricing of hospital and provider services is critical, placing price transparency in the spotlight.

According to Forbes, price transparency is a necessary first step toward a better healthcare system. In fact, it has become a national priority. Federal legislation and associated regulations now mandate transparent price information with a goal of adding insight, protection and fairness. This is helping patients nationwide gain digital, real-time access to accurate provider and hospital fees, the ability to anticipate the total cost of their care and determine out-of-pocket costs prior to receiving care.

Attention to price transparency comes at a critical time when many Americans are described as “financially fragile.” Most people have not set aside adequate savings specifically earmarked for out-of-pocket medical expenses, including regular cost sharing, deductibles, copayments or coinsurance. A near-confirmed national recession, has Americans anxious over “what’s next” in terms of cost increases and what will add to their financial stress.

Price transparency puts patients in the driver’s seat by enabling them, as healthcare consumers, to shop and compare provider services and save money. This insight has potential to transform an employee’s health coverage usage, putting the economic purchasing power and decision-making in their hands. When combined with broader reforms, patients are empowered to play an active role in managing their health care utilization and controlling their healthcare spend.

Federal regulation
To increase price transparency practices in healthcare, the Centers for Medicare and Medicaid Services (CMS) mandates that hospitals and providers publish meaningful price information for patients. As of January 1, 2021, the Centers for Medicare and Medicaid Services (CMS) issued mandates that hospitals operating in the US provide clear, accessible pricing information online about the items and services they provide. Under CMS guidance and final rules, hospitals are required to make pricing information available in machine-readable format, as well as provide a list of shoppable services that a patient can schedule in advance. This is intended to make information accurate and easier to access for health service consumers to compare prices, estimate the cost of care and assess market value.

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