Price Transparency: How are Hospitals Adjusting?

Payment Cycle Management: All you need to know
May 14, 2021
How to use Enhanced Ambulatory Patient Grouping (EAPG) Systems to classify and calculate reimbursements for outpatient services?
June 10, 2021
Show all

Price Transparency: How are Hospitals Adjusting?

Before the final decision came out about hospital price transparency, many hospitals were hoping that the ruling would be in their favor. They had not started to align their healthcare centers with this new rule where hospitals, healthcare providers, and insurance companies had to disclose their cash. All these institutions had to negotiate contract prices to the patients with an easy-to-understand format to have clarity in the confusing bills they have to pay. 

While some medical practices have complied with the requirements, some are still facing issues. Even though it is challenging for hospitals to adjust to this new pricing methodology, medical institutions are still making adjustments to make a transition. Here are a few adjustments that they have implemented. 

Re-evaluation of pricing

For many medical institutions, considering the rationale behind their pricing methods was something they had not done before or even thought of. Completely changing and implementing a new system is very burdensome, but with the price transparency ruling in place, these institutions re-evaluate their pricing methods. They are trying to align costs and their desired financial outcomes.

Increased pricing

Many hospitals are adjusting to this new rule by increasing the prices of other hospital services. This is because they need to bridge the revenue gap caused by lower prices of the discretionary services. Hence, costs for the emergency department, hospitalizations, and other services will increase to adjust with price transparency. 

Considerations

Implementation of this new ruling has begun, but to comply with it is taking longer. Hospitals, healthcare providers, and insurance companies have a lot to consider, which is why the process is taking longer. For instance, there is a fair amount of analytics and other dynamics of the entire system that needs to be taken into account to meet the objectives of the final transparency rule. 

Struggles in the adjustment

This transparency rule also needs the hospitals to submit data that they do not have. The data includes information from the payers like contracts with entities that lease payer networks. To gain access to this kind of data is outside the contractual authority of the hospital. Other than that, even if they somehow get the approval to get this information, many staff members will have to devote time. This will significantly affect the rural facilities because they have limited time and resources. These requirements will consume valuable time which could otherwise be used to deliver quality and efficiency. 

With these struggles, efforts are still being made to meet all the requirements of the price transparency rule. 

Experts believe that it will ultimately come down to hospitals and medical providers playing on their strengths to reach a competitive market price. By looking at the market and the actual costs, only then will a medical practice stay afloat in the market. Not just that, prices will become much more competitive for discretionary services to adjust with price transparency. As hard as it may be, medical institutions are making the necessary changes to meet the rule.

Discover The Ultimate Pricing Transparency Solution

If you are interested in a free demo of our AllPayor® Software, please go HERE or you can register for a FREE webinar HERE