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CMS Launches Online Tool to Promote Price Transparency


The CMS's new tool will give patients more information and power moving forward.

This image has been altered. Photo licensed by boti1985 - stock.adobe.com

The Centers for Medicare & Medicaid Services (CMS) launched a new online tool today that allows consumers to compare Medicare payments and copayments for certain procedures that are performed in hospital outpatient departments and ambulatory surgical centers.

The Procedure Price Lookup tool, accessible on Medicare.gov, provides users with national averages for the amount Medicare pays the hospital or surgical center and the copayment amount that a beneficiary with no Medicare supplemental insurance would pay the provider, according to the announcement. The move comes as part of the 21st Century Cures Act.

“This Procedure Price Lookup tool is needed because the law requires that Medicare maintain multiple separate payment systems for different types of healthcare providers, meaning both CMS and patients pay vastly different amounts for the same service, depending on the site of care,” CMS Administrator Seema Verma, MPH, said in a blog post.

>> READ: Why CMS Is Betting on Telehealth Innovation

In a statement, Verma said that Procedure Price Lookup will help patients with Medicare consider potential cost differences when choosing where to get the care that best meets their needs.

Beneficiaries can type in which surgery they need and see estimates of the difference in out-of-pocket costs between the two settings.

This capability is in line with a vision that Verma has been promoting for several years: where patients may carefully select which healthcare provider works best for them, with the data to support that decision, in a digital format.

Price transparency has also been a big issue for the administration.

CMS launched its eMedicare initiative, for example, to give beneficiaries cost and quality information. eMedicare gives people the opportunity to receive interactive online decision support, which allows them to better understand and evaluate their Medicare coverage options and offers a mobile out-of-pocket cost calculator that gives information on plan and drug costs.

“We must do something about rising cost, and a key pillar is to empower patients with the information they need to drive cost and quality by making our healthcare system evolve to one that competes for patients,” Verma said.

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