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Analysis

New CMS Online Tool Shows Price Differences for Surgeries

By John Commins  
   November 27, 2018

Procedure Price Lookup provides Medicare patients with price differences for some surgical procedures in hospital outpatient and ambulatory surgery center care venues.

The Centers for Medicare & Medicaid Services on Tuesday launched an online tool that allows consumers to compare Medicare payments for surgical procedures in hospital outpatient departments and ambulatory surgical centers.

The Procedure Price Lookup tool displays national averages for what Medicare pays the provider, and the national average copayment fpr a Medicare beneficiary with no supplemental insurance.

"Working with their clinicians, the Procedure Price Lookup will help patients with Medicare consider potential cost differences when choosing where to have a medical procedure that best meets their needs," CMS Administrator Seema Verma said in a media release.

The Procedure Price Lookup tool was mandated by Congress in the 21st Century Cures Act.

Medicare statutes require that CMS maintain separate payment systems for different types of healthcare providers, meaning both CMS and patients may pay different amounts for the same service, depending on the care venue.

"The different payment rates are a prime example of Medicare's misaligned financial incentives, under which providers can make more money if they see patients at one location as opposed to another," Verma said in a blog post.

"Unfortunately, it would take an act of Congress to change the payment systems within Medicare that charge patients different prices for the same services based on the care setting, but in the meantime patients have the right to at least know what they will be charged," she said.

Procedure Price Lookup is the latest online tool created under CMS's eMedicare initiative, whose other patient-oriented transparency tools include an overhauled version of the agency's drug pricing and spending dashboards that lists the drug makers who were responsible for price hikes.  

“The different payment rates are a prime example of Medicare's misaligned financial incentives, under which providers can make more money if they see patients at one location as opposed to another.”

John Commins is a senior editor at HealthLeaders.


KEY TAKEAWAYS

Procedure Price Lookup is CMS's latest effort to improve pricing transparency for Medicare beneficiaries.

The tool was mandated by Congress under the 21st Century Cures Act.

CMS's Verma raps 'misaligned' payment rates based on surgical venues.


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