Put a finger down if you’ve ever 1) had surgery or another medical procedure 2) received unexpected or confusing bills for the service 3) tried to understand the healthcare system to no avail 4) given up and concluded it’s all a racket where everyone but the patient has control over cost and quality.
If you put down multiple fingers, you aren’t alone, since this describes the reality of navigating the healthcare system for many Americans.
However, this reality is being recognized and addressed. Recent rules released by the Centers for Medicare and Medicaid (CMS) reform payment structures to create transparent, no-surprises costs, patient choices, and focus on real medicine instead of ideological agendas.
First, building upon the work of the No Surprises Act, CMS directed hospitals to provide allowed negotiated prices (10th/median/90th percentile) with signed compliance attestations, instead of the previously required price estimates. This will allow patients to not only factor cost in their selection of care, but also to see the spread of prices from different insurance carriers.
Second, several changes allow patients to receive their care in less expensive settings, such as physician clinics and ambulatory surgical centers (ASC), instead of hospitals or hospital-owned outpatient clinics. These reforms include adding 289 new procedures to the list of allowable surgeries at an ASC, removing a parallel 285 procedures from the in-patient only list (IPO) with steps toward removing the IPO list entirely, and removing hospital facility fees from certain services performed in an outpatient setting. This removes much of the up-charge patients see presently as a result of the premium cost for care provided in a hospital (or a hospital-owned clinic, which constitutes a majority!). It will also allow freedom for providers to open more non-hospital clinics, providing much-needed alternatives for patients.
And last but not least, CMS has quietly removed several social justice mandates from their rules, but let us not be quiet to praise this move. Social determinants of health reporting, health equity commitments, and COVID vaccination mandates do not improve patient health, and should rightly be removed. Providing transparency, accessibility, and affordability instead will allow health to once again be at the center of healthcare.
Using the space these new rules create, Texas should continue to lead in healthcare policy reform, removing any additional barriers to true patient choice, and amplifying innovation.
