May 7, 2021


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The CMS price transparency rule also provides a win for suppliers and payers

The Hospital Price Transparency Regulation It was celebrated as a great victory for the patients Cut off as a burden On health care stakeholders. The rule is that Effective January 1, despite the fact that Medicare and Medicaid service providers won on Tuesday. Intended to delete a section This year begins October 1 for the next fiscal year.

But suppliers should start respecting and not because Regulation is generally expected to stop.

What is lacking in the pricing regulation are the opportunities available to payers and suppliers.

Of course, there are ways in which they can use the regulation to publicly share pricing information. These include being able to use pricing information effectively, support contract negotiations, and build trust with patients to increase their competitiveness.

For suppliers, the first big advantage of the regulation is a better understanding of their competitors’ services and contracts, said Mimilman, a risk management product manager, benefits and technology company.

“With this knowledge providers can market their unique value differences or add new services or packaged offerings to attract new patients,” he said.

For example, if a Cancer Specialty Hospital administers high doses of chemotherapy drugs – making their services more expensive than their competitors – they may be prepared to engage patients more effectively by demonstrating the potential outcomes and providing context for those costs.

In addition, printing and comparing prices can help hospitals cut fat. By using the data, you will be able to assess the basic cost structure of their services and identify the vast majority of those who work in the market or even in the healthcare system, said Cave Safavi, CEO of World Health Consulting, by email.

He said service providers should consider this regulation as an option to re-evaluate their service delivery strategy.

In the same way that suppliers can use visibility to pay rates to support good contract negotiations, Milman’s chief executive and advisor said in an email.

For example, if a payer sees that one of its main competitors is getting lower contract rates with a particular provider, it will eventually result in lower premium rates, and that payer now has information that supports low-cost bargaining.

“[And] If the provider does not want to provide a higher payer, the payer may disconnect the provider from the network or consider options in the network’s unselected network. ” In doing so, the taxpayer may urge other suppliers in the market to enter into an agreement that will increase the market share. ”

Perhaps the biggest advantage of the transparency regulation for both stakeholders is the ability to strengthen relationships with patients.

“Finally, transparency is focused on finding ways to return to the true value of winning the zero-sum game between the payer and the provider.

While providers may be afraid of patients changing facilities because of the price, research shows that this is not the case. About half of the 2,000 U.S. consumers (46%) say they want pricing information for financial planning purposes rather than buying care. 2018 Accent Report.

Providers and payers can help patients plan their expenses by providing resources to better understand “my value” and membership benefits, said Robert Murphy, Managing Director of Payment Accounting Health and Public Services.

He said both decision makers and payers have the opportunity to build trust with members by sharing timely and accurate pricing information. It is important to shift from thinking about submission to developing members.

Preliminary reports indicate that The price transparency rule is low. But when suppliers and payers look at the differences in the rule, they may find that it works not only for them but also for their benefit.

Photo: feellife, Getty Images