Now that the public comment window has closed on the 2020 OPPS proposed rule, we’re less than a month away to seeing the rule finalized, due out on November 2, 2019.
Moving forward with becoming price transparent as an organization is in your hospital’s best interest, and to your competitive advantage. A key component to getting started down the path of price transparency is to form a committee with physician leadership, revenue cycle leadership, managed care and analytical personnel.
Identify your team, at the highest level, and keep it simple. Too many members will prevent progress. Consider using the American Hospital Association’s Principles for Price Transparency to organize your task force, and posture your information in a way that is easy to access and understand for the patient. You’ll want this to be a working committee, and treat it like a project with weekly meetings and deadlines until the November 2 rule is published. Once we see what the actual requirements are on November 2, you can adjust your timelines accordingly.
As we keep our eyes on what is being crafted at the federal level, we can’t lose sight of what could be brewing at the state level here in Georgia regarding price transparency.
Georgia’s Lieutenant Governor has formed a task force that meets three times before the next legislative session so we could be seeing new legislation at the state level in 2020 as well.
Think of about five people in your organization who should be on your Price Transparency Committee:
Chairperson
The first thing the chairperson should be doing is to level set. They should go through the executive order, the proposed rule for 2020 and really help the group define what price transparency means to their organization.
After defining what price transparency is, the most immediate thing they should be looking at is the requirement right now which is proposing that you put 300 machine-readable shoppable services on your website. 70 of those are pre-selected by CMS, so you’ll need to look at those 70 services listed, and determine whether you provide those.
Chargemaster Analyst
The chargemaster analyst needs to be the person on your Price Transparency Committee looking at prices across the organization as it’s not unusual for the same procedure done in different departments within the same hospital to cost something different. It would be pretty bad if one of your shoppable services cost something different in multiple places within your hospital.
Business Analyst
You’ll want someone on your committee with a business analytics background. Since you won’t just be reporting prices of procedures, you’ll also have to provide what comes with those specific procedures. If you’re listing a colonoscopy, for example, you’ll also need to list out what else is being done to a patient as part of the colonoscopy. You’ll have to do some analytics to provide a holistic picture of what that procedure looks like.
Your financial analyst will really need to look back at historical data to see what was grouped together with a named shoppable service. You’ll need time for this type of analysis.
Physician’s Champion
They’ll play a critical role in educating the clinical staff on what price transparency is.
Revenue Cycle
You’ll need someone from Revenue Cycle because they’re going to own all of those aspects that interact with the patient from giving a price quote, to financial counseling to helping to schedule.
Get the Executive Buy-In
You’ll need to clearly articulate how difficult it is to achieve price transparency and the complexities that come with that. You’ll really want them to understand what is, but also, that if done well, price transparency is a true competitive advantage for your hospital.
How do you achieve price transparency?
The ability to provide a patient with out-of-pocket costs prior to a procedure, and have them go through financial counseling is key in achieving price transparency. There’s not always a good understanding of what that looks like or the complexities of it at the executive level. Here are a few helpful tips to get the executive buy-in to help you move forward with attempting to achieve price transparency:
- Step 1: Spend a lot of time providing education on what price transparency is for your board and for the C-suite. Don’t shortcut this step as they’ll need to understand the why and how before you can proceed.
- Step 2: Identify those champions who do get it and those who believe that this is something that we have to do and will help you make price transparency a reality.
A True, Competitive Advantage
Some hospitals are already rolling out the ability to do estimates on their websites, are linking to scheduling procedures online, linking to financial counseling, and they view it as something that makes them different and easier to deal with.
If you’re able to clearly articulate the out-of-pocket cost of a procedure to a patient, they’re going to want to work with you over another hospital who provides confusing information, or none at all.
To discuss implementing price transparency further, contact Denise Gaulin.
