Six months after the implementation of the Federal Hospital Price Transparency Rule Take effect, Few facilities fully meet the requirements. last week, Washington post Advocacy organization patient rights advocate published a report This indicates Of the 500 hospitals randomly sampled, only 28 (that is, 5.6%) met all the requirements of the transparency rules.
The vast majority are non-compliant, including some of the most famous health systems in the United States-the New York Presbyterian Church, Cedars-Sinai Medical Center, Rush University Medical Center, Geisinger Medical Center, and Mountain Medical Center.
However, these 28 compliance agencies include large, resource-rich organizations, regional health systems, and independent hospitals from across the country. This shows that size and location have little to do with the likelihood of complying with the rules. For a complete list of compliant and non-compliant hospitals, Click here.
Interviews with several compliant hospitals revealed some things in common: they started early, Work closely with technology suppliers and persist in meeting the challenges that arise.
The rule stipulates that hospitals must publicly share the prices of at least 300 public services and items that they negotiate with payers, such as MRI scans and renal function panel tests. The hospital must display the price in two ways: As a machine-readable file that contains all goods and services, and displays shopable services in a consumer-friendly format.
For most organizations that have spoken to MedCity News, finding the right technology partner and starting work early is critical to ensuring compliance.
Cheyenne Regional Medical CenterThe hospital’s assistant compliance officer, Christy Craig, said in an email that a 206-bed hospital in Wyoming began working to comply with the proposed rule in 2019 after it was published.
“For our organization, the most important step is to select a software vendor that can meet all the compliance requirements of the regulation,” she said.
Hospital and Health catalyst Collect the payer’s contract information, claim submission documents and reimbursement documents, and then compile them for publication.
Are located in Memphis, Tennessee Baptist Memorial Healthcare, Including 21 affiliated hospitals, and General Brigham In Boston, which consists of 14 hospitals, relying on existing epic system.
Ron Wachsman, vice president of revenue cycle, said in a telephone interview that Baptist Memorial Health Care uses functions provided by Epic to aggregate data from various sources including health system leaders. The health system collects a wide range of data, from patient accounting information to payer contract data.
After collecting the data, the health system works with Epic to absorb and review the data.
“We do have millions of rows of data,” Wachsman said. “So, if you take into account all the different prices and our person in charge, the number of hospitals multiplied by the number of contracts, this is really a huge project.”
Similarly, Mass General Brigham designed a technical solution around its Epic system, Mary Beth Remorenko, vice president of revenue cycle operations, said in an email.
“This work includes identifying machine-readable document components, using consultants to construct large machine-readable documents, adding all contracts to [the] The Epic contract module allows payers to output contract rates and significantly expands our online patient estimation template,” she said.
The health system also started working on its price transparency very early-in fact, before the proposed federal rules were issued.
“When the requirements for the large document were released in 2020, we included it in our plan,” Remolenko said. “Although we are aware of the American Hospital Association’s lawsuit [which ultimately failed], We did not suspend execution and wait for the court’s ruling like some people do. “
Although the supplier provides early start-up and technical support, ensuring compliance with the rules is not easy.
Wachsman, vice president of revenue cycle, said that for Baptist Memorial Health Care, combining the different skills required by its internal team is the biggest challenge.
Compliance involves processing large amounts of data and auditing, as well as setting up mandatory machine-readable files and displaying shopable services in a way that is meaningful to consumers.
Therefore, the health system must leverage the expertise of people working in its IT, managed care, decision support and analysis, business offices, and registration departments to achieve compliance, he said.
Remorenko of Mass General Brigham responded to a similar obstacle: the technology required to build and publish large files is advanced, beyond the scope of its internal team, requires additional internal and external resources, and the subject matter expertise required for interpretation Some of the more general aspects of horizontal rules.
She said that there is still a question of time. As the Covid-19 pandemic destroys the resources of medical institutions, medical institutions need to work hard to increase price transparency.
“I think our internal commitment to this work and our ability to work with Epic and other companies contributes to our compliance,” Remorenko said.
But this commitment to price transparency seems to be rare in the US health system. Therefore, the government has taken a tougher stance on law enforcement.In the new rules announced three days after the Washington Post’s report, the Center for Medicare and Medicaid Services Severe punishment is recommended For non-compliance: Each hospital has fines ranging from US$10,95 to US$2 million per year.
Whether this is sufficient to improve compliance remains to be seen.
Photo: adventtr, Getty Images
