CMS Medicare Pay Data Sparks Healthcare Price Transparency Debate

April 18, 2014

The attention given to CMS' Medicare payment data by the media demonstrates a continued focus on greater transparency at medical practices.

Last week's release by CMS of Medicare Part B data on payments to physicians has once again ignited discussion of the need for transparency in healthcare cost information.  

The nation has turned its focus from hospital charges - the topic of much recent news coverage and a prior CMS data release - to physician reimbursement. And while the media's interpretation of the CMS data and the implications of that data for consumers continue to evolve, one lesson is clear: The call for transparent, readily accessible information on physician charges will not soon be diminished. Indeed, other developments such as websites that offer providers the opportunity to "bid" on treating a given patient as well as legislative efforts to require physicians to inform patients of their charges as they relate to out-of-network care all indicate that making charge information readily available in some fashion to consumers will become an integral part of running a physician practice.

Many physicians are already embracing the trend of greater price transparency, and are harnessing it to foster goodwill with their patients. While the foundation of strong doctor-patient relationships will always be a physician's commitment to offering high quality, evidence-based treatment, patients also appreciate practices that acknowledge and incorporate the financial implications of healthcare decisions in their patient interactions. This is particularly true as more consumers enroll in health plans that carry greater cost-sharing requirements.

Physicians can demonstrate their commitment to engaging with patients around the cost of their care by providing upfront information about a practice's charges. This sets a tone that helps patients to feel comfortable in broaching a topic - physician prices - that has traditionally been considered off limits in exam room conversations. When recommending procedures that may not be fully covered by a standard insurance plan, note this fact in discussions with patients. Help them to understand their insurance coverage and how various reimbursement provisions fit into treatment plan options. And take advantage of free resources such as those offered by FAIR Health that are intended to educate consumers about the reimbursement system and how to apply cost information to their healthcare decisions.

The shift to making charge information more transparent can be more comfortable when a practice utilizes robust, independent sources of market data to help inform the development of fee schedules. Unbiased, robust third-party data sources can help advance such evaluations of a practice's charges.

The media storms that have accompanied the release of new data on healthcare prices can sometimes distract from meaningful physician-patient discussions. Focusing on how these developments can benefit patients is a winning strategy for weathering such storms and for improving practice management and patient relations over the long term.