Earlier this month, CMS released the much anticipated final calendar year (CY) 2020 rule for the Medicare Outpatient Prospective Payment System (OPPS). While many were expecting specific guidance regarding CMS’s controversial proposal for greater hospital pricing transparency regarding privately negotiated rates within the rule—in fact, per the American Hospital Association (AHA), hospitals have already committed resources to complying with the new proposal requirements—the new conditions were noticeably absent. Instead, CMS briefly acknowledged pricing transparency in a few sentences, noting that the agency was still considering the many messages it received regarding the proposed final rule during an open comment period.
Lovisa Gustafson, MBA, assistant vice president at the Commonwealth Fund, says there was a lot of speculation on why the provisions were missing from the CY 2020 OPPS final rule.
“In terms of the transparency requirements being pulled out as a stand-alone rule, the truth is we didn’t know the exact reason,” she says. “Many speculated that it was to partition the broader CY 2020 rule from the complexity, and potential legal challenges of the transparency provisions.”
Yet, just two weeks later, on November 15, 2019, CMS unexpectedly dropped the final ruling regarding hospital transparency as well as new proposed transparency provisions regarding coverage for insurers. In a public announcement of the two rules, HHS Secretary Alex Azar called the provisions “revolutionary changes for our healthcare system.”
"Today's transparency announcement may be a more significant change to American healthcare markets than any other single thing we've done, by shining light on the costs of our shadowy system and finally putting the American patient in control,” he said.