Revenue cycle leaders express concern over price transparency rule

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Although hospitals see value in price transparency, a majority are concerned about significant challenges around deployment of CMS' price transparency regulation, according to a KLAS survey of 66 revenue cycle leaders. The regulation stipulates hospitals must provide clear, accessible pricing estimates online for at least 300 different shoppable services.

The survey revealed the majority of respondents are concerned significant resource investment will be needed to sustain price transparency and indicated there is widespread confusion regarding the expectations and needs required by the regulations. More than half of survey respondents said they were concerned the implementation and build-out of price transparency systems would continue to eat up valuable resources.

One unnamed vice president of a revenue cycle noted meeting the requirements has added "significantly" to the cost of healthcare. There were also two main technical sticking points regarding the regulation in its current form, one of which requires healthcare systems to produce pricing information files as machine-readable, and the other concerns the regulation's requirement that providers publish a master list of rates online.

Hospitals are turning to third-party solution providers, among them Experian Health, Vitalware and nThrive, to help satisfy price transparency requirements. Among vendors who also provided EMR services, Epic was mentioned far more often than Cerner.

While survey respondents appeared less satisfied overall with price transparency solutions offered by EMR providers, the results indicated hospitals would switch over the EMR-provided solutions in the future as part of a drive toward vendor consolidation.  

WHAT'S THE IMPACT?

In a federal price transparency rule that took effect January 1, 2021, hospitals were tasked with posting all their prices online in clear, easily accessible formats. The survey indicated that hospitals are generally in favor of such regulations as a step towards the consumerization of healthcare.

Concerns over price accuracy and whether patients would fully understand the complexities of procedure costs were augmented by fears from smaller hospitals that consumers would be lured to larger healthcare organizations that, by virtue of their size, could offer lower rates.

More requirements will go into effect starting on January 1, 2023, and January 1, 2024, which will provide additional access to pricing information and ostensibly enhance consumers' ability to shop for the healthcare that best meets their needs.

THE LARGER TREND

A February survey found just 14.3% of 1,000 hospitals are compliant with the price transparency rule, and just two of the 361 hospitals owned by these three hospital systems were compliant with the rule.

The results were in line with earlier findings, published in June 2021 in the Journal of the American Medical Association and the American Journal of Managed Care, showing that most hospitals are not compliant with the price transparency rule.

The penalty for noncompliance is a maximum of $300 per day, but the study in JAMA said that the cost of disclosure of negotiated rates could be greater than any fines.

ON THE RECORD

"Like everybody else, we are reactive, and we do what we can. But we are hesitant to do more than what is expected or written because the price transparency rules may change," said one anonymous business office director quoted in the report. "We don't want to invest in technology or third-party vendors that are ill prepared for changes."

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Email the writer: nathaneddy@gmail.com