CMS Clarifies Expectations on Price Transparency
Episode 7519th April 2021 • This Week Health: Newsroom • This Week Health
00:00:00 00:07:05

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 Today in Health it, this story is new guidance from CMS on price transparency. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in Health IT a channel dedicated to keeping health IT staff current and engaged. VMware has been a sponsor of Today in Health It since we started.

They recently completed an executive study with MIT on the top, healthcare Trends, shaping it, resilience, covering how the pandemic drove unique transformation in healthcare. This is just one of the many resources they have for healthcare professionals. For this and several other great content pieces, check out vmware.com/go/healthcare.

Alright, here's today's story. This is from Modern Healthcare CMS. Issues new guidance to enforce price transparency rule. If you're not familiar with the price transparency rule on November 12th, HHS and the Department of Treasury and Labor issued rules to encourage price transparency for consumers to compare varying costs and quality of care.

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But as of early February, 65 of a hundred largest hospitals in the US did not comply. According to research by Health Affairs, many did not put out any files or provided broken links to databases. Alright, so let's take a look at the new guidelines. CMS issued new guidance on GitHub for developers and consumers of the machine readable files required through the transparency in coverage rule after an investigation showed what we just talked about in a statement to Modern Healthcare.

CMS said they're committed to ensuring that consumers have the information they need to make fully informed decisions regarding their healthcare and will enforce these rules to make sure Americans know. A hospital charges for healthcare. The new guidance first posted on March 23rd says that all files uploaded by health plans and health insurers must be in formats available to the public without restrictions that would impede the reuse of that information On the platform, experts are answering questions and providing examples of file layouts and data displays.

Compliant with the current price transparency regulations. Prior to the guidance, some files were being tagged with code written to keep search engines like Google from indexing names and prices listed on hospital websites. The Wall Street Journal first reported that hundreds of hospitals embedded this code into their sites so that web crawlers could not pick it up, making it difficult for consumers to access, which is a no-no.

Some hospitals have been fighting the price transparency regulations, arguing that consumers do not use price estimators to determine their care plans and releasing payer specific rates could increase prices as the lowest cost providers adjust to the average. The American Hospital Association lost a suit to block the rule on the basis that HHS lacks the authority to oversee its regulations.

And such rates are not useful to consumers. The organization also made a statement calling the regulation a subjective, oversimplified analysis of hospital transparency efforts during the pandemic hospitals are required to provide clear accessible pricing information online according to CMS and the hospital price.

Final Rule mandates all machine readable files and their content be accessible without barriers and searchable for consumers. On the new guidance released on GitHub, CMS says they expect hospitals to comply with these requirements. All right, so what, as you know, we end all these stories with the, so what sort of, why is this important?

Why does it matter? I think the first, so what is the information is out there? They're making it more clear what they expect, what the file should include, how the file should be put out on the website, where it should be put, and how accessible it should be. This was necessary. The initial rule was a little vague.

It wasn't real clear where to put the file. Wasn't real clear what the file should look like, and so it was open to a lot of interpretation. That interpretation led to a lot of odd types of things. Organizations were having trouble finding the files. Individuals couldn't possibly find the files unless they set aside hours in the day to find it on their local health system website, so that's great.

They're clarifying the rule and that was necessary. The second, so what is really about public relations? The arguments that are being used against price transparency just don't hold water. I understand that there is no elasticity of demand based on price in healthcare today, but that doesn't mean there isn't going to be in the future, and it doesn't mean that we should not have transparency when we say that we are consumer centric and then we

Strive to hide our pricing and to keep things as opaque as possible to the consumer. That is the antithesis of being consumer-centric. You don't understand this pricing. It's too complicated. We can't possibly put it in your hands. That is the opposite of being consumer-centric. If you're gonna be consumer centric and you really care about the consumer, educate them.

These are the 200 shoppable services that you can find in, in our file. This is how you read this file. This is what this information means. Instead of trying to hide it, keep it from search engines, and quite frankly, not put it out there at all. I think it's a, I. Public relations mistake, I think health systems are gonna start getting called out.

They're gonna get called out into the national media, like the Wall Street Journal and other locations, especially the largest hospitals and the academic medical centers. But it's going to get down into the local news and the local papers. So those are my two. So whats the information's out there?

They're providing clarity. And then the second is . Understand what you're communicating to the community that you're trying to serve. You're essentially saying you can't be trusted with this information. You're not smart enough to understand this information, and we don't want you to have it. And that is the opposite of being consumer centric.

That's all for today. If you know of someone that might benefit from our channel, please forward them a note. They can subscribe on our website this week, health.com, or wherever you listen to podcasts. Apple, Google Overcast, Spotify, Stitcher, you get the picture. We are everywhere. We wanna thank our channel sponsors who are investing in our mission to develop the next generation of health leaders.

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