Operation Recovery Episodes

Operation Recovery: Price Transparency with Jeff Leibach

Key Takeaways

  • Price Transparency Rule Key Items: 
    • Hospital Prices 
    • Standard charge file 
    • Price Scrutiny 
    • Increased Price Competition 
    • Machine – Readable 
    • 300 Shoppable Services File 
    • Consumer Friendly File 
    • Revenue Rebalance Pricing Model 
  • Under the price transparency rule hospitals are required to show their prices in two forms. 
    • A comprehensive machine-readable file
    • Consumer friendly file, this is more for customers and gives the customer 300 shoppable services. 
  • Pricing elements exempt from the rule
    • Patient out of pocket spending 
    • Exact rate information
    • Hospital comparison
  • How will HHS enforce these rules 
    • Written Warnings 
    • Corrective Action Plans 
    • Civil Monetary Penalties
  • Strategic Options for Providers 
    • Assess Current Rates v. Market Rates 
    • Conduct Strategic Pricing and Risk Assessment 
    • Implement Short – term managed care strategies and compliance / noncompliance plans 
    • Design and implement long – term managed care rebalancing strategies to reduce future risks.