FinancialHospitalsRegulatory

With price transparency an inevitability, hospitals need to start working toward compliance

September 15, 2020 / Jeff Lagasse, Associate Editor

Recently, a federal judge upheld the Centers for Medicare and Medicaid Services’ final rule for hospital price transparency, and the implementation date is rapidly approaching on January 1, 2021. Yet many hospitals have not yet begun preparations to align with the new requirements.

There are reasons for that, including the COVID-19 pandemic and the hope that the court would rule in their favor. But now, with only a few short months left, the time has come to consider what the new guidelines require and to work towards a smooth transition.

The final rule, issued in November 2019, requires hospitals, other healthcare providers and insurance companies to disclose their cash and negotiated contract prices to patients in an easy-to-access format, in an attempt to clarify confusing bills that illuminate little about the actual out-of-pocket costs patients are required to pay. 

For some of these hospitals, it may be the first time they’ve considered the rationale for their pricing. Implementing a new system can be burdensome, but in this case it also represents a potential opportunity for administrators to re-evaluate their pricing methodologies, and better align pricing with both costs and their desired financial outcomes.

According to Caroline Znaniec, managing director in CohnReznick’s healthcare practice, there’s still some hope among hospitals that CMS will delay the requirements or give more time to comply with requests. But to date it doesn’t appear that’s going to happen, and so the time has come for hospitals to consider their first steps toward implementation.

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Chris J. Stewart

Chris currently serves as Chief Executive Officer of Surgio Health as well as COO at Ortho Spine Partners. Chris has close to 20 years of healthcare management experience with an infinity to improve healthcare delivery through the development and implementation of innovative solutions that solve real problems that result in improved efficiencies, reduction of unnecessary financial & clinical variation, and help drive better patient outcomes. Previously, Chris was assistant vice president and business unit leader for HPG/HCA. He has presented at numerous healthcare forums on topics that include disruptive innovation, physician engagement, shifting reimbursement models, cost per clinical episode and the future of supply chain delivery.

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