May 20, 2021

Price Transparency Solution Partnerships Usher in Benefits for Patients and Providers

Hospitals have endured one of the toughest years ever, with many finding it difficult to get in compliance with the Health and Human Services Price Transparency ruling that went into effect on January 1. In fact, a March Health Affairs analysis of the largest 100 U.S. hospitals found that 65 were “unambiguously non-compliant,” with mixed levels of compliance in others. Meanwhile, CMS is moving to make compliance a reality:

• The agency sent initial warning letters in April, giving hospitals 90 days to comply.
• Civil monetary penalties and a published list of non-compliant organizations may be next.
• CMS provides a link for submitting complaints on the CMS website if it appears a hospital has not posted the required information online.

No one disputes that achieving price transparency in healthcare has been challenging. Providers, insurers, and patients all have struggled to find a solution that meets the various needs and motivations of all parties. Still, healthcare costs continue to rise, and the healthcare industry has remained largely opaque.

Yet, as the latest actions from CMS make clear, the Price Transparency rule is the new reality. Patients demand clarity around the cost of healthcare services. They understand that increased visibility can drive competition and lower costs.

Hesitant hospitals—and hospital struggling to comply—may wish to consider solution partnerships to meet the Price Transparency requirements.

As administrators at the Coffeyville Regional Medical Center have seen, a qualified partner makes it easy to compile and post the required machine-readable file with rates and a file with the 300 shoppable services required by the ruling.

“What will it cost?” is the most common question we hear,” explains Shannon Uhrmacher, who serves as Coffeyville’s director of Patient Financial Services. “We serve elderly patients and farmers, and they—like us—need to be careful about where the dollars go.”

Now that Coffeyville Regional Medical Center has met the CMS requirements with the help of RevSpring, they’re on a roll. Shannon says they will be adopting patient access solutions—including our price shopping and price estimation tools—that solve for patient pain points and open the door to early payment options.

“These additional tools will give patients a chance to be aware of costs in advance. It also will allow our staff to work with patients to get the care they need, instead of putting it off because they just don’t have any idea about what it will cost. This will be a big decision-making benefit for patients going forward,” she adds.

Fostering an environment of clarity, responsibility, and empowerment can move the opaque healthcare financial environment to one of transparency and trust. As some hospitals already are learning, a pre-service financial experience that meets these criteria contributes to improvements in financial health for patients and providers.