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Price Transparency Rule is a Burden for Hospitals

Analysis  |  By Jay Asser  
   April 29, 2022

Revenue cycle leaders are concerned about the efficacy of the regulation and the resources required to implement it.

Many revenue cycle leaders believe the price transparency rule is too confusing and expensive to achieve its intended purpose, according to a KLAS report.

While the respondents in PDF iconthe report feel price transparency allows for more patient empowerment and fights the consumerization of healthcare, they doubt the efficacy of the regulation.

CMS' price transparency rule went into effect January 1, 2021, and requires each hospital to provide pricing information online for at least 300 different shoppable services.

To gauge how hospitals are responding to the regulation and their plans with price transparency, KLAS interviewed 66 revenue cycle leaders over the past year.

Though nearly half of the respondents say that price transparency will significantly or moderately improve patient financial outcomes, over half who answered moderate improvement believe the existing regulation needs additional clarification and federal guidance.

"There are concerns about cost, data accuracy, and patient adoption of pricing tools; some respondents worry about patients’ ability to understand the displayed pricing data, and today, most patients are unaware online pricing information exists or are unsure of how to interpret it," the authors of the report state.

Meanwhile, 26 respondents believe the rule will have no improvement on patient financial outcomes, and seven feel it will cause moderate or significant deterioration.

The two aspects of the regulation that many respondents are highly dissatisfied with are the requirement to use machine-readable files containing pricing information, and the requirement to broadly publish online a master list of rates.

To implement and sustain price transparency compliance, most respondents say significant resource investment is necessary. However, finding resources can be difficult as organizations weigh the financial burden of investing in a regulation that doesn't provide a return on investment, according to the report.

"This lack of investment can be problematic since knowledgeable and experienced resources are required to keep the pricing information accurate and compliant," the authors say. "Over the next year, respondents expect they will need to continually invest in people, processes, and technology to meet price transparency mandates."

The report states that hospitals are more likely to use third-party solutions rather than their electronic medical record (EMR) vendor, with 36% of respondents saying third-party vendors are best positioned to lead in price transparency.

Though satisfaction rates are higher with third parties, some respondents who currently use a third party say they will consider moving to their EMR vendor's platform to consolidate systems.

Ultimately, the report states that CMS' regulation is confusing and organizations are unclear on how to approach it. While some respondents say their organizations have brought in consulting groups, and other say they have educated their employees about the rule, the number and types of resources required is still uncertain.

"Many organizations are not investing beyond the bare minimum requirements, and they don't plan to do more until there is further clarity around the regulations and the expectations going forward," the authors conclude.

Jay Asser is an associate editor for HealthLeaders.


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