Overview of States’ Hospital Reference-Based Pricing to Medicare Initiatives
Last Updated October 7, 2021
To address high hospital prices, some state health purchasers are using reimbursement rates paid by Medicare as a reference-point to inform their programs’ hospital payments. Through these Reference-Based Pricing to Medicare (RBP) initiatives, state purchasers are seeking to set their reimbursements to more accurately reflect the cost of providing services, rather than negotiating from the much higher hospital chargemaster rates. To date, each state program is establishing its payment as a multiple of the Medicare rate, so the provider will continue to receive a rate higher than that paid by Medicare. Additionally, programs are using RBP to inform the cost of the service but are not necessarily adopting Medicare’s fee-for-service approach. State programs continue to use value-based purchasing arrangements and other payment methodologies. This chart provides a snapshot of state RBP efforts.
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
