Zeamed Healthcare welcomes The Centers for Medicare & Medicaid Services (CMS) consumer tool that allows buyers to compare surgery prices for their own practical benefit.
CMS launched an online tool that allows consumers to compare Medicare payments, Medicare allowable amount and the patient portion (co-payments) that are performed in hospital outpatient departments, and ambulatory surgery centers (ASCs).
The consumer resource Procedure Price Lookup allows Medicare patients to compare payments and co-payments for procedures that are performed in hospital outpatient (provider-based) departments and ASCs. The tool displays national averages for the amount Medicare pays the hospital or ambulatory surgical center as well as the national average copayment amount for a beneficiary with no Medicare supplemental insurance to pay the provider.
For instance, say a Medicare beneficiary needs his or her kneecap repaired. The surgeon offers the choice to have the surgery in the hospital outpatient department, or at an ASC. With this tool, the patient can see an average estimate of the difference in out-of-pocket costs between the two centers as shown in the table below:
- Repair of knee cap (Code: 27437)
Ambulatory Surgery Centers
- Average Medicare Pays: $2177
- Average Total Cost (allowable amount): $2721
- Average Patient Pays: $544
- Hospital Outpatient Departments
- Average Medicare Pays: $4485
- Average Total Cost (allowable amount): $5606
- Average Patient Pays: $1121
Difference
- Average Medicare Pays: $2308
- Average Total Cost (allowable amount): $2885
- Average Total Cost (allowable amount): $2885
- Average Patient Pays: $577
Here, if the patient chooses hospital outpatient instead of the ambulatory surgery center, the burden on Medicare is $2308 and the patient is $577 with a total wastage of $2885.
Simply, ZeaMed echoes the CMS price transparency initiative to empower patients where health care systems evolve to compete for patients. When quality information is integrated into price transparency, the consumers will feel emboldened to seek high-value care among providers competing on both cost and quality.
The tool can be used by uninsured, underinsured, and people with high deductible health plans to negotiate a better price with providers.