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Price Transparency Rule: Hope is Not a Strategy

There are about 100 days until CMS’s new price transparency rule goes into effect. While health systems and the American Hospital Association hope that their ongoing legal challenges will provide at least a stay in this requirement, hope as we like to say, is not a strategy. And even if the rule is somehow blocked, price transparency will continue to be a priority for CMS and legislators in Washington.

Health systems need to prepare immediately on how they would plan to publish a public price list of their standard services, which include private payor-negotiated rates on 300 services.

We know consumers regularly point to wanting more clarity on costs and want more information to help them compare out-of-pocket costs among providers. Perhaps more concerning than consumers wanting to know where to get the best deal, providers must be ready for local and national media to compare rates of local hospitals, calling out those that are outliers for higher prices. Health systems need to be prepared.

And managed care teams must also prepare for payers to compare their negotiated rates with their competitors. This will lead to challenges during the next contract negotiations for health systems, given much of this previously proprietary information is required to be public. Managed care teams need to look at their current pricing strategies to see what, if anything, can be adjusted before year-end. It’s a race to the bottom for health plans, how are you preparing?

September 18, 2020
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