August 2, 2019- by Steven E. Greer, MD
President Trump recently signed in June of 2019 the Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First that requires the Secretary of Health and Human Services to generate reports and proposed new rules that will allow patients to shop for elective healthcare services knowing the real prices charges. Plans to eliminate surprise out-of-network billing are also part of the executive order.
In rapid fashion, Secretary Azar has published the rules that will go into effect in January of 2020. The actual rules can be downloaded here. A summary of the rules is found here.
Buried at the end is something important to hospitals:
“In addition, CMS also proposes to expand the number of procedures payable when furnished in either the ambulatory surgery centers or outpatient hospital departments, such as knee replacements (Total Knee Arthroplasty) and certain coronary intervention procedures. These changes would give patients more choices on where to obtain care, improving beneficiary access and convenience and lowering out-of-pocket expenses.”
When cases are performed in free-standing operating room facilities owned by the actual doctors, the facility fee is usually much less than if a tertiary care hospital performed them. That is likely why CMS inserted this into the rules.
The Healthcare Channel has been warning hospitals that they are in for some major disruption soon. These ortho and cardiology cases are their bread and butter. Doctors will start to open their own clinics and take the revenue away.