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Healthcare Transparency: Cooling pandemic intensifies regulatory fever


The pandemic has dominated healthcare in 2020, but it will not be seen as a reason to delay compliance with the price transparency requirements of CMS that came into effect on January 1, 2021. Health affairs Indicates that as of February 2021, 65 of the 100 largest hospitals in the United States have not complied with the regulations. The new CMS report indicates that if the CMS warning letter has no impact, in addition to potentially causing the public to expose non-compliant facilities, it will also face a daily fine of $300.

Learn more about how we can help increase price transparency

There are many reasons why price transparency has attracted so much attention before and during the COVID pandemic. Consumer advocates point to other transaction experiences, such as car and home purchases, in which understanding the price is complicated, but it has been realized. There are also many studies on the impact of price transparency on patients; helping consumers understand health care bills can reduce the pressure on their financial experience. In many cases, transparent pricing also makes sense for providers. They may benefit from patients being able to plan the cost of care, thereby reducing missed payments and write-offs.

For these and other reasons, price transparency has been a hot topic in the past few years. Center for Medicare and Medicaid Services (CMS) The final rule of price transparency Effective January 1, 2021, hospitals are required to provide patients with clear information about their medical expenses, including a list of charges for the hospital’s 300 most frequently purchased services, so that patients can make informed decisions.Payer should provide Similar pricing information From January 1, 2022.

The focus on healthcare pricing seems unlikely to dim anytime soon. What does this mean for suppliers and payers?

Price transparency will continue

Have Legal challenge They opposed the final rule of price transparency, challenged federal authority, and invoked violations of constitutional rights, but the DC Circuit Court rejected these claims in December 2020.

The argument against the current authorization is not limited to disputes over legal authority. It shows that the government should not interfere with private sector pricing—complex pricing information may have the opposite effect and confuse consumers. In fact, many suppliers and payers have expressed support for price transparency, but it is not as proposed in the final rule. Despite this, consumers’ demand for price clarity before providing services continues to grow, and current government regulation is by far the most far-reaching attempt to solve this problem.some State legislature Are advancing their own regulations, which may prompt more Local cooperation Communication between provider and payer to clarify out-of-pocket cost estimates. Achieving the level of transparency desired by CMS and consumer groups will be challenging, but attempts to find common ground are increasing.

Under the Biden administration, what will price transparency look like?

Since President Biden entered the White House, the trend of transparent pricing has continued.Providers’ compliance has been slow-many pointed out that 12 months of fighting COVID were the main reason-prompting Legislative pressure Strengthen auditing and punishment. CMS has begun to release Violation warning letter Moreover, although it may revise the ruling under the leadership of the new government, there is no indication that there are any plans to reverse the policy.

Consumer Action Group Concerns about inadequate regulations have been expressed on the grounds that consumers may have difficulty finding pricing on supplier websites. Other consumers are limited to the rate negotiated by the payer and have no choice but to stick to the current supplier. Providing information may be an early step towards final price transparency, but making information easy to find, understand, and act on is what consumers value—and many suppliers and payers say they want to provide it in a more customized way. One-size-fits-all apps.

Price-transparent marketing strategy

As patients assume more responsibility for health care costs, they begin to look forward to a consumer experience that provides them with more control and choice.A kind Pioneer Research Institute It was found that 70% of healthcare consumers want to check pricing information before undergoing medical procedures. Actively communicating the promise of price transparency can be a powerful marketing strategy to attract and retain loyal consumers.

Not surprisingly, this kind of information resonates better User-friendly tools Instruct patients to complete their financial journey and understand the costs. Many suppliers believe that they have complied with the final rules, but may actually be susceptible to penalties because their pricing documents are in a format that is not user friendly.

A kind Web-based pricing tools This problem can be helped by providing patients with accurate estimates and recommended payment plans before or at the point of service.Similarly, text to move tools such as Patient Financial Advisor, Can send automatic text messages with personalized estimates and bills to patients.

Pay attention to health care price transparency

More tools are now available to help patients understand their bills, and vendors and payers can more easily create financial experiences that support patients from the start. This will not only help patients understand the cost of their care (and with this understanding may lead to better collection performance), it will also help reduce the risk of unpaid care-and avoid penalties when the final rule takes root.

The Biden administration’s focus on consumer-friendly healthcare services may prioritize price transparency. The situation in the next few years depends on regulation and market forces, but both providers and payers will benefit from providing meaningful solutions for their organizations and patient groups.

Understand how Experian Health’s price transparency tool Can help your organization transition.



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