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These rates are mandated of payers, not providers (outside of hospitals), and essentially every national plan has published rates online for all providers they
by colinmorelli 3y ago
These rates are mandated of payers, not providers (outside of hospitals), and essentially every national plan has published rates online for all providers they contract with. They are not the cash pay rates, because that is not how most patients consume healthcare.
Second, there is a standardization of codes for the most common procedures one would shop for, which is CPT. There are HCPS, DRG, and other codes as well - but they’re much less common among the types of care one would reasonably shop for in advance. A crosswalk between code sets is also possible for many procedures.
There is certainly not a standardization of the use of codes in all cases, which I alluded to in my message. It’s extremely challenging to know what codes you will receive. And placing provider malice aside, often times providers themselves do not even know what it will be before going in.
To this end, bundled episodes have become increasingly common for certain types of procedures. But it’s far from exhaustive and there’s much room to go.
In any case, the goal was never for this data to be directly used by patients. It was to expose the data, and make it available for third parties. Most of those efforts have fallen flat not for lack of data, but lack of a patients ability to reasonably engage with it for the reasons mentioned above.
You can see more about the act here: https://www.cms.gov/healthplan-price-transparency/plans-and-issuers https://www.cms.gov/healthplan-price-transparency/plans-and-...