By Howard Bright, vice president of patient engagement, RevSpring.
“Life keeps throwing me stones and I keep finding the diamonds.” – Ana Claudia Antunes
I appreciate that philosophy because it applies to so many situations, including the federal price transparency regulation that goes into effect on January 1, 2021. Many providers are dreading the new rule and all that complying with it will require (it’s hardly a secret that the industry has actively resisted the ruling). But a careful look can reveal “diamonds”— major competitive advantages, improved revenue collection and even increased patient loyalty—for hospitals that see and seize the opportunities.
It’s understandable considering the problems that many providers have experienced with price estimation tools in the past. To be clear, the ruling does not require hospitals to provide explicit price estimates. What it does mandate is the following:
“Make standard charges public in two files displayed prominently on the Internet and updated at least annually.”
One of those files must be “machine readable” (J-SON, XML, CSV) and include all “items and services.” The other must be a “consumer-friendly shoppable services file,” that uses plain language, descriptions and codes covering 70 CMS-specified items and services and an additional 230 hospital-specified items and services.
While that might sound relatively straightforward, most hospital administrators and revenue management leaders know that the devil, frequently, hides in the details. And when viewed through the lens of the patient, those details could prove to be tremendously overwhelming. Making the mandated information easy to access and patient specific—and even providing an interactive price shopping tool that gives patients simple ways to act—is where the competitive advantage lies for savvy hospitals and hospital systems.
In other words, don’t view the ruling simply as an onerous data requirement but, rather, as a communications and patient engagement opportunity. By providing data that is clear, concise, consistent, and easy for human beings to understand, not only will you meet a true consumer need you will set your hospital apart from competitors.
Most will probably do the bare minimum by publishing their insurance negotiated rates as the mandate requires and others will risk the consequences of non-compliance. In a recent webinar I provided on this topic, 36 percent of attendees said they were “still investigating options for how to comply with the ruling” and a shocking (at least to me) 8 percent said they had “not started yet.”