New online tool lets Medicare recipients compare surgical procedure prices

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The Centers for Medicare and Medicaid Services (CMS) announced the release of a new online tool Tuesday that allows Medicare recipients to compare prices for certain outpatient surgical procedures.

Specifically, by entering a procedure name or code into a search bar, the “Procedure Price Lookup” tool reveals the national average cost of a procedure at a hospital outpatient facility to the cost of the same procedure at an ambulatory surgical center. The tool provides the average total cost (the “Medicare approved amount”) as well as the average amount Medicare will pay and the average patient copay for both types of facilities. The data provided are for a patient with Original Medicare and no supplemental policy.

The tool has been on its way for a while — its creation was mandated by the 21st Century Cures Act, which was signed into law in December 2016.

“Price transparency in health care is a priority for the Trump Administration,” CMS Administrator Seema Verma said in a statement. “Working with their clinicians, the Procedure Price Lookup will help patients with Medicare consider potential cost differences when choosing where to have a medical procedure that best meets their needs.”

The tool is a simple web portal. (Screenshot)

Play around on the tool for a few moments and you’ll notice that prices are lower at ambulatory surgical centers. This, Verma explains in a blog post, is because Medicare is required by law to maintain separate payment systems for different types of facilities. Verma isn’t happy about this, calling it “a prime example of Medicare’s misaligned financial incentives.”

“Unfortunately, it would take an act of Congress to change the payment systems within Medicare that charge patients different prices for the same services based on the care setting, but in the meantime patients have the right to at least know what they will be charged,” she writes.

The Procedure Price Lookup tool fills this role.

Of course, price isn’t the only consideration patients need to make when thinking about where to have a procedure done. Ambulatory surgical centers are popular because they tend to be smaller with more personalized care. Hospitals, however, are generally thought to be safer for high-risk surgeries because of the infrastructure and emergency care options they have.

The portal is part of CMS’s recently launched “eMedicare” initiative, which aims to update the online experience the agency gives Medicare beneficiaries.

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Centers for Medicare and Medicaid Services (CMS), Department of Health and Human Services (HHS), Medicare, Seema Verma
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