Pricing Transparency

Building Trust with Transparency

What can hospitals do to address the need for transparency in their pricing?

The federal government and patients are now calling for increased price transparency of hospital prices

The second CMS pricing transparency law, the Hospital Outpatient Prospective Payment System (“OPPS”) Price Transparency final rule took effect January 1, 2021. The new rule requires hospitals to make prices (charges) for their services available online in a “machine readable” format. Hospitals must also make negotiated rates and cash prices available, as well. While several hospital organizations filed a lawsuit to stop the rule, the requirement to publish prices will remain in place.

The message is clear: the government wants the public to be able to access, understand, and compare prices among healthcare providers. But patients want it, too. As consumers are now price shopping, with quality and outcomes in consideration as well, it will be critical for hospitals to respond by displaying a defensible, strategic pricing strategy aligned to and accessible for the market.  It’s up to healthcare providers and insurers to make this a reality.

What do I need to do to maintain pricing transparency?

Leverage the most advanced strategic pricing tool on the market

The requirements of the new January 2021 CMS ruling are straightforward, albeit hotly debated and even challenged in court. Healthcare providers must:

Pricing transparency for healthcare providers is here to stay. And with it, providers face increasing risk of negative publicity, difficult questions, and even decreasing volume as a result of more traditional pricing strategies.

Hospital pricing and payment has long been confusing, but today, the “user experience” for consumers is coming front and center. Hospitals are continuing to increase net revenue with more defensible, patient-friendly, and market-aligned pricing.

To maintain pricing transparency, your organization can leverage StrataJazz® cost data alongside purpose-built algorithms, comparative market data, detailed payer contract terms, and insight into care/cost/patient population variation to drive far more strategic and defensible pricing.

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Create defensible, strategic, and informed pricing

Accurately and effortlessly model the impact on reimbursement by payer by using actual contracted terms

Price to the market while maintaining visibility into the impact of price changes on revenue

Improve the patient experience by providing complete visibility into prices

Identify and adjust prices to match their fee schedules and model the impact of price changes on reimbursement and payer limits

Use automation and algorithms to deploy strategic, well-defined pricing methodologies across your health system

Use pricing as a lever to increase reimbursement and improve margin