Although the deadline to meet federal price transparency requirements has passed, many U.S. hospitals are still working to ensure compliance with the regulation.
To comply with the price transparency rule, which took effect Jan. 1, hospitals must publicize privately negotiated, payer-specific rates online. Hospitals must post a machine-readable file with all items and services offered and display prices of 300 shoppable services in a consumer-friendly format.
If CMS finds a hospital is noncompliant, it may request a corrective action plan, assess a civil monetary penalty of up to $300 per day or publicize the penalty on a CMS website.
In a Jan. 28 webinar, sponsored by IBM Watson Health and hosted by Becker's Hospital Review, two industry experts discussed common challenges and offered tips to overcome them and comply with price transparency requirements.
The presenters were:
- Betsy Block, associate partner, IBM Watson Health Provider Consulting
- Jim Haulihan, associate partner, IBM Watson Health Provider Consulting
Five takeaways from the webinar:
1. Compliance with the machine-readable file component is low across the country. An informal survey conducted by IBM Watson Health on Jan. 22 found that just 2 of 17 hospitals in New York City had their machine-readable file published publicly, while many more were compliant with the shoppable services component, Mr. Haulihan said. This reflects what IBM Watson Health is seeing at hospitals across the U.S., he said. "The issue that many hospitals are facing is more so around pulling together the machine-readable file, and/or feeling comfortable sharing those rates and posting that information online," Mr. Haulihan said.
2. Machine-readable files are complicated and time-consuming, but it is important to have them. Machine-readable files can be complicated and time-consuming to make, given the complex nature of posting rates for all available services for hundreds of payers, Ms. Block said. However, hospitals should still make an effort to have them available to ensure compliance. "We don't believe that it's worth the risk of being added to the public list of noncompliant hospitals," Ms. Block said.
3. Payers will soon need to disclose the negotiated rates, too. Many hospitals are hesitant to post their negotiated rates with payers online, especially if they are in a competitive service market, the panelists said. However, by the end of the year, payers must create and display a machine-readable file of their negotiated rates with providers. "It makes it a very short time window of risk because those rates are going to be revealed anyway," Ms. Block said.
4. Focus on revealing prices for outpatient services like labs or imaging. New Hampshire implemented a price transparency rule in 2007. An analysis of the state rule revealed that consumers shop for care when they have to pay out-of-pocket. More patients shopped for outpatient services, such as lab or imaging services, rather than the more complex inpatient services, Ms. Block said.
5. Know how your prices and quality metrics compare to other health systems. It is important to understand how your organization's rates and quality metrics compare to other providers in the market, Ms. Block said. She added that hospitals should be ready to explain these comparisons to patients and payers.
To learn more about the price transparency rule and solutions that can help hospitals quickly comply, view the full webinar here or visit https://www.ibm.com/watson-health/learn/price-transparency-healthcare.