Given the increase in patient demand and new rules from the Centers for Medicare and Medicaid Services (CMS), price transparency is now mandatory for U.S. healthcare facilities. With new requirements in effect as of July 1, 2022, and more set for 2023 and 2024 — and many providers still struggling to comply — here’s a four-step healthcare price transparency strategy that leaders can start implementing today.
Today’s Healthcare Price Transparency Rules: How We Got Here
Even before the pandemic upset what was already a volatile situation for medical pricing, increasing transparency has been a priority for the federal government. Controversial though it may have been, 2019’s Hospital Price Transparency Final Rule was a game changer, requiring disclosure of “hospital pricing data to degrees heretofore not seen,” as Health Affairs reported at the time.
“This is probably the most significant change to health policies since the Affordable Care Act,” as Amino CEO David Vivero told Employee Benefit News.
The requirements that went into effect on January 1, 2022 sought to make health plans and sponsors more responsible for unexpected out-of-network charges. The goal was to protect patients. The result, though, includes new obligations for hospitals and healthcare facilities to publish or otherwise make available an annual list of charges imposed for the services they provide.
The new healthcare price transparency rules mandated that facilities display five types of information, from patient-friendly “shoppable services” to comprehensive files of all negotiated rates. That’s no small task, and it may be little surprise that many have struggled to comply — a situation that wasn’t helped by Covid-19, which sprang up between the rule’s finalization in 2019 and its 2021 effective date.
Because of the pandemic, the enforcement of the original 2019 healthcare price transparency rule and some 2021 updates had been delayed until July 1, 2022. As of February 2022, it had been reported that only about 14% of all hospitals were in compliance. The American Hospital Association (AHA) disputes this figure, claiming that fewer than 200 hospitals were noncompliant as of July, 2022.
Whichever interpretation may be correct, the confusion itself is part of the problem. Uncertainty about compliance could complicate efforts to achieve transparency, and leave facilities exposed to additional risk of fees or penalties at a time when enforcement is just beginning.
4 Steps to a Successful Healthcare Price Transparency Strategy
The upshot is that, however challenging the task of getting there, achieving price transparency for hospitals can offer a significant benefit. Today’s patients are more demanding and discerning than ever. They expect the high quality of customer service, personalization and attention they receive in the retail setting in the healthcare setting too, and will be more inclined to seek out this feature.
“More than two-thirds of patients polled said every step of the healthcare access process is a chore, and nearly every respondent said they want it to be equally simple to shop for healthcare as it is other consumer goods and services,” as Xtelligent Healthcare Media’s Sara Heath reported.
By delivering transparency requirements like the consumer-friendly shopping services, facilities can help offer that simplicity. It’s also a powerful tool for offering a better patient experience across the board, which can boost a healthcare organization’s chances to compete as a business. And this can all help build patient trust, too, which can result in greater engagement and satisfaction.
With all of this in mind, here’s how leaders can implement a healthcare price transparency strategy that actually works, in four steps.
Step #1: Don’t skimp on due diligence.
The first step in complying with new healthcare pricing transparency rules is doing the research and understanding the specific requirements and obligations facing each facility. This may seem straightforward, but still requires real expertise.
As the AHA’s Ariel Levin points out, some of the rules are easy to misinterpret. For instance, CMS offers clear guidance on how to fill in details on individual negotiated rates in the event of a bundled payment. However, some groups mark this as “noncompliant,” which may affect whether a facility officially meets the standards in case of an audit.
Step one, then, is to make sure the team responsible for implementing transparency rules are clear on not only exactly what’s required, but how to report compliance for each item. Yet as we’ll see, that’s no small task, and may involve the use of outside help.
Step #2: Make compliance a company-wide effort.
For a compliance strategy to truly work, it’s important for leaders to set an example. By prioritizing a task that’s too easily and often put off, leaders can inspire their entire organizations to work toward successful compliance. And, given that meeting the rules is a complex undertaking, that organization-wide buy-in isn’t just a good idea but an operational necessity.
This includes not only the obvious departments like legal, regulatory and finance, but also clinical teams, technical workers and even marketers. As Jacqueline LaPointe writes in another Xtelligent report, proper marketing of the availability of healthcare price transparency can help improve utilization and raise patient awareness of the tools that will ultimately be available to them.
Step #3: Invest in the necessary tools.
Compliance with the new healthcare price transparency requirements has been lagging no doubt because of the amount of time and money needed to get up to date.
“Hospital price transparency compliance requires time and resources—two things many hospitals don’t have to spare,” writes LaPointe.
One way to ease this burden, as she points out, is to invest in specific applications designed for this kind of task, such as an online price estimator tool for patients. Automating this information as much as possible saves significant time, which can directly translate into saved labor hours for healthcare facilities.
And for easier implementation, this can all be placed within the context of an organization’s larger digital strategy. After all, the value of any healthcare company’s website can be measured in how easy it is for patients to use. Implementing a price estimator tool that can fill this important role is part and parcel of having a workable website — an asset that every business needs, stat.
Step #4: Invest in the right expertise.
Just as with a redesigned website, the successful implementation of transformation tools often requires the assistance of outside expertise. Don’t be afraid to engage third-party assistance to meet these goals. True, the initial cost of doing so can be intimidating. But in the long run, the job will get done more quickly, efficiently and cost effectively, helping organizations avoid potential missteps and penalties.
In addition to any outside legal counsel that may be necessary to ensure your organization is fully up to date, help can also be found from clinical workforce solutions providers. Healthcare managed service providers (MSPs) and vendor management services (VMS) are designed for just this purpose — to help organizations achieve compliance with every applicable regulation.
These providers also offer a rich variety of additional benefits, including the automation of time-consuming tasks related o billing and scheduling, updating and implementing new technologies, and helping bolster cybersecurity at a time when healthcare is the world’s number one for target for hackers.
Need a Hand Implementing Your New Healthcare Price Transparency Strategy?
CareerStaff has led the field in healthcare workforce solutions for decades, offering hospitals, health centers, SNFs, LTCs and many other types of healthcare facilities the tools and expertise they need to succeed in a competitive market. Find out how we can help you meet your healthcare price transparency goals: Learn more about our workforce solutions here.