The Hospital Price Transparency Rule celebrated its first birthday in January, and as of July 1, enforcement of similar requirements for payers and health insurance began through the coverage transparency rule. Unfortunately, the United States has not yet achieved the intended outcome of price transparency (more shoppable healthcare), or even understand what the outcome should be. The key compliance indicators vary, and in fact, the definition of “compliance” itself varies, with estimates ranging from 6% to over 50%, depending on how the data is sliced.
True “compliance” means that the hospital publishes both price data. user friendly When Placed prominently on their website (Yes, this also includes making it easy to get information through search engines). By this definition, compliance is undoubtedly low because many hospitals do not create accessible resources to find and understand pricing. This is probably not surprising, as hospitals balance a myriad of challenges, including staffing crises, COVID-19 surges, and the struggle to recover profits.
Given these hurdles, hospitals that are not yet in compliance will not feel the pressure to make changes unless additional positive or negative incentives work. The vague requirements and lack of impact do not create the sense of urgency that regulators have hoped for. So where are we going from here?
The price transparency rules are intentional, but they have a fatal flaw. There is too much room for interpretation in the definition of compliance. Healthcare professionals need to ask themselves what compliance really does. Do hospitals need to publish prices in easy-to-find locations labeled on their website, or can these numbers be resolved by placing them on hidden pages? If the industry wants better compliance, the Medicare & Medicaid Service Center (CMS) will provide clear rules, including what is expected and what is banned, ensuring potential loopholes in the process. You need to close it.
Many providers see this rule as a burden of regulatory compliance rather than a potential opportunity to differentiate themselves from their competitors and increase market share, so there is little incentive to comply. There is none. Remember that the hospital failed in court trying to thwart these transparency requirements. In addition, the first civil fines associated with the breach were laughingly low when intended as a deterrent. The CMS recently fined for the first time for non-compliance. This totals over $ 1 million and is expected to increase compliance efforts. On the contrary, only two hospitals have been fined, even though the CMS has sent hundreds of hospitals in writing warnings of violations in recent months. These fines can get the attention of the hospital’s chief financial officer, but it’s still unclear if they see these fines as just “business costs.” Even a $ 1 million fine can be a hospital round-off error. The bottom line. The CMS can significantly increase the pressure on hospitals to comply if they choose, by raising private fines or by associating compliance with transparency rules with the conditions for participation in the Medicare program. Employees are vaccinated. However, it is not entirely clear whether the legislation covering the conditions of participation would allow the CMS to take this type of action.
In addition, there are additional external factors that can influence the transition to increased price transparency, including the fact that hospital rules do not exist in isolation.Although it is difficult to predict the impact of hospital Future development of price transparency Payer The rule of transparency can only expect the payer to pay attention to the struggle of the other party. At first, confusion can occur if the payer becomes aware of the difference in bargaining rates with the same provider organization. However, combining these rules may give you the opportunity to increase synergies between payers and providers. We hope that this deployment will help improve the shortcomings of our predecessors and ultimately provide consumers with the best information to guide our true ultimate goal of care decisions.
Finally, it’s important to be optimistic. Having endured a clear setback on the road to greater transparency, continuing on the road represents incredible progress in less than a decade. Until 2013, it was almost impossible to get information about provider pricing. In fact, the CMS was legally prohibited from disclosing information that could identify a doctor’s refund. At the time, the disclosure of doctor-level reimbursement information by CMS was considered a breakthrough, but until recently information on the prices of people with private health insurance was hidden. We are making clear progress and the road is bumpy, but our healthcare leaders have a duty to keep moving forward with their patients.
Niall Brennan, MPP, Chief Analyst and Privacy Officer at Clarify Health. He was previously Chief Data Officer at CMS and led the Obama administration’s healthcare transparency efforts.
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