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It appears the Biden administration is going to continue on with the Trump administration transparency work.

FTA

“No medical entity should be able to throttle competition at the expense of patients,” said HHS Secretary Xavier Becerra, in a news release. “I have fought anti-competitive practices before, and strongly believe healthcare must be in reach for everyone. With today’s proposed rule, we are simply showing hospitals through stiffer penalties: concealing the costs of services and procedures will not be tolerated by this administration.”

But this type of commitment to price transparency appears to be rare among U.S. health systems. As a result, the government is taking a harder stance on enforcement. In a new rule announced three days after the Washington Post published the report, the Centers for Medicare & Medicaid Services proposed stringent penalties for non-compliance: fines ranging from $109,500 to $2 million per hospital per year.

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Good thing for patients, a lot of work to complete for health systems.

#healthcare #healthIT #cio #cmio #himss #chime

Transcript

 This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

  Today in health it. We're gonna talk a little bit more about price transparency and I'm gonna retract something I said and put this back on the right track. 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.

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Alright, today's story comes from Med City News. Only 5% of hospitals are compliant with price transparency rule. And here's how they did it. So this is an interesting story and it gives me a chance to come back and talk about this topic in a little more detail. So here's some excerpts from this. More than six months after the Federal Hospital price transparency rule went into effect, few facilities are fully compliant.

Last week, the Washington Post published a report by. Advocacy group, patients' rights advocate that showed only 28 of a random sample of 500 hospitals or 5.6% had complied with all of the transparency rule requirements. The overwhelming majority were noncompliant and included some of the most prominent health systems in the country.

New York Presbyterian, Cedar-Sinai Medical Center. Rush University Medical Center, Geisinger Medical Center, and Intermountain Medical Center. But the 28 compliant facilities included large, small, regional, independent hospitals, which indicated that it really didn't matter what size you were or what your budget was, that you could be compliant, I think is their case that they're making here.

Interviews with a few of the compliant hospitals revealed some commonalities. They started early, worked closely with technology vendors and persevered through the challenges that arose. The rules state that hospitals must publicly share the price they negotiate with payers for 300. Common services, otherwise known as shoppable services such as MRI, scans and kidney function panel tests.

Hospitals are required to present the prices in two ways, a machine readable file with all items and services and display of shoppable services in a consumer friendly format. All right, so that's what you're supposed to do, and only 5.8% of the hospitals are compliant, but then they go on to look at the ones that are compliant.

So Cheyenne Regional Medical Center, 206 Bed Hospital in Wyoming, started working to comply with the rule in 2019 after the proposed rule was published, said Christie, Craig. . The hospital assistant compliance officer in an email. The most important step for our organization was selecting a software vendor that would meet all the compliance requirements for this regulation.

She said the hospital worked with Health Catalyst to gather payer contract information, claim submission files and reimbursement files, and then compiled them for publication. So there's one solution to the problem, both Memphis. Tennessee based Baptist Memorial Healthcare, which includes 21 affiliate hospitals and Mass General Brigham in Boston, which is comprised of 14 hospitals, leaned on their existing Epic systems.

Baptist Memorial Healthcare used the capability provided by Epic to pull together data from various sources, including the health systems. Charge Master said Ron Waxman, vice President of Revenue Cycle in a phone interview, the health system gathered a wide range of data from patient accounting information to payer contract data.

I. Once the data was collected, the health system worked with Epic to assimilate and audit the data. We literally had millions of rows of data. Waxman said, so if you think of all the different prices in our charge, master times, the number of hospitals, times the number of contracts, it really got to be a huge project.

And that's one of the things we've been talking about is that hospital billing and hospital pricing is very . Complicated. So this is not a simple project by any stretch of the imagination. Similarly, mass General Brigham designed a technology solution around its epic system, said Mary Beth Reko, vice President of Revenue Cycle Operations in an email.

The work included identification of machine readable file components, utilization of a consultant to build a big machine readable file. Adding all contracts to the Epic contract module to enable output of contracted rates by payer and significantly expanding the templates for our online patient estimates.

She said the health system also started working on its price transparency efforts early before the proposed federal rule was even released. The article closes with this paragraph, which I think is really interesting, but this type of commitment to price transparency appears to be rare among US health systems.

As a result, the government is taking a harder stance on enforcement, and a new rule announced three days after the Washington Post published the report. The Centers for Medicare and Medicaid Services proposed stringent penalties for non-compliance fines ranging from 109,500 to $2 million per hospital per year.

So just to give you a little more color on the penalties, the agency is proposing a minimum penalty of $300 per day. That would apply to hospitals with a bed count of 30 or fewer and a penalty of $10 per bed per day for hospitals with more than 30 beds. For the latter CMS would institute a maximum daily dollar amount of $5,500.

Despite strong pushback from provider groups, the hospital price transparency rule went into effect on January 1st. And here's another interesting quote, no medical entity should be able to throttle competition at the expense of patients said HHS Secretary Xavier ER in a news release. I have fought anti-competitive practices before and strongly believe healthcare must be in reach for everyone.

With today's proposed rule, we are simply showing hospitals. Through stiffer penalties, concealing the costs of services and procedures will not be tolerated by this administration. All right, so there you have it. Here's my so what? So it feels to me we're finally at the starting point. This administration has made a strong statement that they are going to be enforcing this rule.

They have put the penalties in place for this rule, and it's time for us to become compliant. If you haven't started at this point, there's a fair amount of work to do, but at the end of the day, it's very doable. There's a lot of third parties out there that can help you to do this. Obviously, epic Health Catalyst is out there.

There's others that can help you to do this. But it's just making sense of your own data. I want you to hear how important it is to adhere to the spirit of the rule and the spirit of the rule is this, that people should be able to look and determine where they want to go to get their healthcare. I. as much as possible, and in some cases there's a certain set of services that are gonna be just as good down the street as they are at an academic medical center.

If I'm getting an MRI, I can get that down the street or I can get it at the A MC and I should be able to look at the price and make a decision for myself based on what I want my out-of-pocket cost to be. And if my out-of-pocket cost is $2,000 versus $500. , that should be part of my calculus for making that decision.

And I know that for some reason we have pushed back as health systems and we need to stop doing that. It's giving us a black eye. So the final, so what on this is the rules in place? The penalties are in place. The administration has signaled that they're going to be enforcing it. If you are not making progress on this front, you need to be doing that as quickly as possible.

It is a multidisciplinary project. Need to get the team around the table. Start talking about what it's gonna take to make that successful at your health system. All right. That's all for today. If you know 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.

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