Payers Are Poised to See Changes From Hospital Transparency

In another blow to an industry already beleaguered by the COVID-19 pandemic, a federal judge recently upheld a federal rule that requires hospitals to engage in unprecedented price transparency measures. Health systems are likely preparing to comply with the new requirements even as they await the outcome of an appeal — but health insurers, too, are poised to feel an impact if the regulations go into effect.

The rule, which the administration proposed in July 2019 and finalized in November, would require hospitals to disclose the rates they negotiate with payers for all items and services they offer (HPW 8/5/19, p. 1). That comprehensive set of rates must be available in a machine-readable file online, and hospitals also must display payer-specific negotiated charges for a limited set of “shoppable” services in a consumer-friendly format. The rule is slated to go into effect on Jan. 1, 2021, but the American Hospital Association (AHA) and other trade groups and health systems sued to block it.

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Leslie Small

Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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