Citizens of the United States have always been in the dark about the cost of their treatment until the moment they receive the bill for it. This ambiguity can be burdensome, often elevating the stress levels of the patient who is already experiencing the unpleasantries of their medical condition. The Department of Health and Human Services (HHS) aims to make this uncertainty a thing of the past with the release of the Healthcare Price transparency final rule.
Following the release of the Medicare Outpatient Prospective Payment System (OOPS) earlier this year, the HHS finalized the Hospital Price Transparency final rule on the 15th of November 2019. It mandates hospitals to disclose the standard charges or treatment to patients. The Health Plan Transparency Proposal accompanies the final rule and requires health insurance companies to disclose negotiated rates. Both the final rule and the proposal empower patients to ‘shop’ for services from care providers.
Understanding the Impact of the Final Rule
Hospitals negotiate rates with payers and maintain a profit margin; additionally, cash-paying patients are offered discounts. The dynamic nature of treatment further augments the uncertainty of prices towards the end of a treatment regimen. Care decisions change depending on the prognosis of the patient and they are left feeling the pressure of treatment costs which have always been kept obscured by hospitals.
Giving patients an option to know how much a treatment plan is going to cost them will vastly reduce their anxiety about arranging finances. It also gives them a chance to plan their treatment in advance. Both the final rule and the proposal will now enable them to choose the best fit for their care needs. The proposal also requires payers to offer a tool that provides members out-of-pocket cost information for the services provided.
Since the price transparency final rule requires hospitals to disclose information on the standard charges of treatment to patients, it fits perfectly with the CMS’s vision of bringing healthcare costs down by promoting competition between hospitals. The final rule mandates the maintenance of a single machine-readable file containing information about shoppable services (medical services that can be scheduled in advance by the patient). These details are to be brought to patients by hospitals through their official websites and mobile apps.
Key Takeaways
Maintenance of Standard Charges File: The final rule defines ‘standard charges’ as the price charged by a hospital for a service provided to a patient. This includes payer-specific negotiated charges and discount rates.. All of these details will be disclosed to patients through a database of shoppable services that patients can choose from.
Shoppable Services:- Close to 300 services (that each patient is likely to shop for) are to be provided to patients in a searchable and consumer-friendly manner. Hospitals that fail to make the standard charges and the list of shoppable services easily accessible stand to face penalties that could range up to a couple of hundred dollars (
Transparency Tool: Insurers are required to provide members with a price transparency tool that would be the go-to option for them to access and refer to cost information. This tool would grant members access to price information through their mobile devices as well.
The price transparency final rule and care plan transparency proposed rule together are set to standardize healthcare costs and boost competition among care providers. Despite the promising prospects, the proposal continues to face stiff resistance from providers who are not entirely convinced that price transparency is what patients require.
The date to finalize the proposals of the final rule and the proposed rule has been pushed to the beginning of 2021 and they are currently placed in the 60-day public comment period.
Technological Implications
Following the comment period, both payers and providers will require technology components to host the standard charges file. The services of healthcare IT development firms would be essential to help them with master data management (for the standard charges file) at the outset. This would be followed by admin and user permission models deployment to UI settings configuration of host applications such as the transparency tool, dashboard systems to track user activity, mobile apps
Adhering to the requirements of the Hospital Price Transparency Final Rule and the Health Plan Transparency calls for both payers and providers to invest in mandatory technology changes which include a rigorous application testing schedule as well.
Nalashaa’s services are well suited to enable payers and providers to steer through this crucial change, given our experience with the deployment of a wide array of Healthcare IT solutions for providers and payers.
To learn more about how the final rule is going to impact providers and payers, drop us a line at info@nalashaa.com.
Puneeth Salian
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