EP301: What Is Up With the Hospital and Payer Transparency Rules From CMS Now and Also After January 20? With Jeff Leibach, MBA

In Episode 301, Stacey Richter talks with Jeff Leibach, MBA, director at Guidehouse's Healthcare Practice, about the three CMS transparency rules reshaping hospital and payer pricing — and what they mean for patients, employers, and providers heading into a new administration.

WHAT YOU'LL LEARN

✅ What the three CMS transparency rules require of hospitals and payers, and how they build on each other

✅ Why the hospital chargemaster-posting rule turned out to be mostly useless in practice

✅ How the new machine-readable negotiated-rate files change what patients and employers can see

✅ Why employers may gain new leverage once pricing becomes transparent

✅ Why the administrative burden of complying with these rules is real, and where opposition is coming from

WHY THIS MATTERS

Jeff Leibach walks through three CMS transparency rules as three steps on a ladder: hospital chargemaster posting, machine-readable negotiated rate files for providers, and a more comprehensive payer rule requiring price-shopping across all sites of care. Combined with rules like ONC TEFCA that make patient data more portable, these changes make it easier for patients and employers to price shop and easier for employers to narrow networks — pushing commoditized providers to compete harder on outcomes and experience, not just brand.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction.

05:31 What are the two pieces to the new transparency rule going into effect on January 1, 2021?

06:58 "Any negotiated rate … is required to be disclosed."

07:43 What's the payer rule, and how does it differ from the hospital rules?

10:24 Where are direct comparisons going to come in most useful with transparency rules?

11:16 How does CMS intend these rules to be used?

14:34 "I anticipate employers having a newfound power here."

17:27 Why is there opposition to transparency in health care?

18:27 "The administrative burden is real."

21:03 "I think commoditized is a word we're going to hear a lot more."

22:55 Where is CMS headed under a Biden administration?

26:22 What barriers can tech help break down, and what other opportunities are there for tech right now?

28:49 What should payers be preparing for right now?