Five Takeaways

THE CMS TRANSPARENCY MANDATE: TURN A LIABILITY TO YOUR ADVANTAGE

To comply with the CMS price transparency rule, hospitals have posted their chargemaster online. Patients don’t understand these documents, so they don’t benefit from this exercise, but competitors can leverage this transparency to get ahead.

During an April 24th webinar, Doug Fenstermaker of Warbird Healthcare Consulting discussed how providers can turn transparency to their advantage before it becomes a liability. The entire webinar can be accessed at www.modernhealthcare.com/TransparencyMandate.

The current billing process is too confusing. Providers must make it easier to understand.

Posted prices can confuse and scare patients. Providers can combat this fear by clarifying out-of-pocket expenses and combining all facility and physician fees into a single price, irrespective as to whether the physician is employed or an independent practitioner. Providers that are able to work within their existing physician relationships to present a single, agreed-upon price to the patient will avoid the confusion of the billing process and create a more efficient revenue cycle.

Find a tool that serves your needs, and figure out where to start.

Providers should seek out a tool that advances price transparency and supports efforts to create bundled pricing for select services. Start by rolling out price transparency to service lines where you believe it can have a significant impact and a straightforward implementation. Imaging can be a great, straightforward place to start. Providers have also seen success in offering self-pay bundles for surgical procedures, including bariatric and orthopedic procedures.

While price transparency is positive for patient-consumers, it gives your competitors an advantage.

Now that you’re an open book, your competitors will advertise discounted rates against the prices listed on your chargemaster. While this may include other hospitals, it’s more likely that nontraditional, freestanding competitors like imaging centers, urgent care clinics and emergency centers will do this in an attempt to take away your business. The rise of consumerism among patients is creating a demand for clearer information about potential providers — a trend that high-quality providers are well-positioned to capitalize on.

Providers can compete by providing an easier, more informed consumer experience.

Providers looking to differentiate themselves should look to the world of e-commerce. That means going beyond simply posting prices by offering relevant safety and quality information, comparative prices and the ability to make quick-click purchases. It also means providers need to market their strengths and leverage the consumer perception that traditional health systems provide higher-quality care.

Improvements to self-pay can help providers avoid the downfalls of the traditional revenue cycle.

Increasingly, consumers are insured under plans with very high deductibles that they’re unlikely to meet in a calendar year. These patients present an opportunity for hospitals who are able to offer an easy self-pay experience and competitive prices. When done right, an increase in self-pay means patients pay quickly and easily, physicians get paid promptly and everyone avoids the significant costs of collection and denials. Ultimately, that means higher satisfaction for both patients and physicians, along with an improved bottom line with virtually zero cost to collect.