The Hospital Price Transparency Rule – Current Industry Situation

The Center for Medicare and Medicaid Services (CMS) has finalized the hospital price transparency rule. The mandate directs care providers to provide patients with a consolidated list of their standard medical services with their costs before admission.

The latest attempt from the CMS to standardize healthcare pricing, the hospital price transparency final rule is more of a double-edged sword than a scalpel that it was intended to be. The announcement of the final rule has been met with extensive adulation at one end of the spectrum and fierce resentment at the other.

The group of individuals applauding this latest effort from the CMS are patients mostly, while hospitals are protesting the proposal. Many care providers opine that the price transparency final rule is counterproductive to the actual cause. They believe that it will simply lead to care providers spiking the price of care delivery in a bid to earn more through standardized costs.

Amidst all the activity surrounding the final rule, it is set to become a mandatory initiative that hospitals are required to conform to the mandate by January 1, 2021. This gives all healthcare providers and hospital associations almost an entire year to contest the mandate or think about its healthcare IT implications.

Here’s What’s Next

Care providers are going to need the assistance of ISVs to develop systems that will bring the details of standardized prices to the patients. The idea behind the final rule was to create a resource that would carry a pricelist for over three hundred standardized services provided by a hospital. This resource would contain details of individual services, including a detailed description of it.

To complete the chain of information and to make the CMS’s vision come true, it is going to take the collective effort of providers and software development companies.

Since January 1, 2019, the CMS has required hospitals to provide their patients with a list of standard charges through a database that would be accessible over the internet. The price transparency final rule builds upon this initiative by requiring hospitals to make payer-specific negotiated service charges, the range of de-identified maximum and minimum charges, public.

This database will include details such as HCPS codes to help patients track the prices of medical services. It would also contain the details of service packages all the individual items under them.

Conceptualizing The Price Transparency Tool

 Implementing the master data repository, to host all the data related to the standard services provided by a hospital and their cost would require a focussed approach. This software tool would provide access to patients, doctors, payers and other users from any location in the United States. It would also need to be exhaustive in detail, while also accommodating changes in the data. Ideally, the price transparency tool would need to have the following essential features.


To achieve these functionalities hospitals and clinics would require some serious firepower in the web and mobile development department.

A great place, to begin with, would be by choosing a Content Management System (CMS). Popular content management platforms like WordPress, Drupal, Joomla and more are all well suited to handle the functionality requirements of a price transparency tool. These platforms are also efficient, consistent in terms of performance.

Most importantly these systems are capable of scaling well according to the size of a hospital, the number of services it offers while also providing support for portal content changes as and when regulatory changes that affect treatment plans are released.

Technology Components

 The price transparency tool would be integrated into the website of every hospital. This would give patients seamless access to standard services and their prices. A hierarchy based system comprising of master and administrator based models would supervise the addition and modification of data. This would help hospitals maintain accurate and high-quality data on the price transparency tool.

The standard library management and user management functions of the content management platform would help hospitals be precise and concise about their medical service offerings.

The use of subcategories would guide an end-user to know about medical procedures that have finer levels of details under them. Physical therapy and Occupational therapy, for example, are of many types. The cost of these services would change based on patient preferences and their health conditions.

Exploring ‘Advanced’ Settings

 Almost all CMS tools have data analytics features. This would be ideal for hospitals to know patient behavior in more detail. The following are some of the most important insights that care providers would get by leveraging data analytics:

  • What is the most commonly sought after service?
  • Demographics and Affordability of the Patient
  • Effectiveness of the Medical Service
  • Common ailments that patients experience
  • Opportunities to improve the user experience of the transparency tool

The price transparency tool can also be integrated with popular CRM offerings such as Dynamics 365. This would help care providers leverage data visualization features and touch base with patients to suggest personalized healthcare.

The possibilities with technology for hospitals to adapt to the hospital price transparency rule are immense. To find the ideal implementation path and think about the road ahead, hospitals need the expertise and experience of a seasoned Healthcare IT provider.

Nalashaa helps hospitals, clinics, and general physicians practices leverage the advantages of healthcare technology with ease. Drop us a line today to know more about what is expected out of care providers when the hospital price transparency rule is made mandatory. Drop us a line today at

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Puneeth Salian

Puneeth Salian

A writer in Healthcare domain, who is also a science and technology enthusiast. Enjoys creating interesting pieces that elucidate the latest Healthcare IT trends and advancements.
Puneeth Salian

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