Biden resumes and violations of transparency of hospital prices


The Biden administration wants to increase fines for hospitals that do not make clear and accessible information on prices available online, according to the outpatient pay proposed by CMS rule on Monday.

The agency has proposed raising the minimum fine for violations of the hospital’s price transparency rule to $ 300 per day for hospitals with 30 or fewer beds. Hospitals with more than 30 beds should pay $ 10 per day for each bed up to $ 5,500 per day. Hospitals could face annual fines of $ 110,000 to more than $ 2 million, depending on their size.

“As President Biden made clear in his executive order to promote competition, a key to price equity is price transparency,” HHS Secretary Xavier Becerra said in a statement. “No medical entity should be able to accelerate competition at the expense of patients. I have fought anti-competitive practices before and I firmly believe that healthcare should be within everyone’s reach. With today’s proposed rule, we are simply showing hospitals with more severe penalties: hiding the costs of services and procedures will not be tolerated by this administration ”.

Less than 6% of hospitals are fully compliant with the federal requirement that health systems publicly disclose the prices they pay for health care, according to a recently published report.

The Biden administration also wants to plan the phasing out of the hospital-only list and restore patient safety criteria to assess whether Medicare should pay for outpatient surgical centers for a given procedure. In its 2021 outpatient payment rule, CMS has allowed outpatient surgical centers to perform nearly 270 additional procedures as of this year. But Medicare expects to stop reimbursing most of these services in 2022, according to a CMS fact sheet.

“CMS has reviewed all service procedure codes that have been removed and have not found any complete criteria for removal, with insufficient supporting evidence that the service can be performed safely in the outpatient Medicare population,” he said. CMS said in a statement.


Hospital groups and several experts have argued against the end of the list just for patients, saying the move could jeopardize quality and safety because many of the procedures are at high risk. Hospitals are also concerned about how the move will affect their finances since it would likely lead to more treatment in parameters at lower costs. But the Trump administration has said quality and safety issues have been overshadowed, with former CMS administrator Seema Verma noting that commercial payers are already paying for such services outside of the hospital environment.

CMS expects to update prospective outpatient payments and outpatient surgery center rates by 2.3%. The agency based the fees on the 2019 claims data instead of the 2020 claims data due to the pandemic.

The agency also wants to launch the Radiation Oncology Model next year with the five-year benefit period starting January 1, 2022. CMS has proposed to change the base period from 2016-2018 to 2017-2019. . CMS wants to lower discounts to 3.5% and 4.5% for the professional and technical components, respectively.

In addition, CMS asked the healthcare industry for feedback on addressing health equity through its quality programs for hospital outpatient departments and outpatient surgical centers.

“CMS is committed to addressing significant and persistent inequities in health outcomes in the United States and today’s proposed rule helps us achieve this by improving data collection to better measure and analyze disparities between programs and policies.” , said CMS administrator Chiquita Brooks-LaSure in a statement. “We are committed to finding opportunities to respond to the health needs of patients and consumers wherever they are, both by expanding access to on-site care in their communities, ensuring they have access to clear information on healthcare costs, or improving patient safety ”.

Similarly, the agency is seeking more information on the flexibilities for mental health services it should hold after the end of the public health emergency and the implementation of a new payment model for rural hospitals that accept to liquidate internal care and to build outpatient services.

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