The provider price transparency rule finalized by the Centers for Medicare and Medicaid Services (CMS) requires providers to publish standard charges for a list of 300 schedulable, non-emergency procedures. Industry associations lost their challenge of the rule in federal court. While appeals are likely, providers would be well served by assuming the mandate will go into effect as scheduled on Jan. 1, 2021, even if the COVID-19 pandemic delays the compliance enforcement date. Pricing transparency gives providers the opportunity to reimagine how they deliver care and how consumers will shop for healthcare services if given clear information.
Of the 300 procedures, CMS has mandated 70 services for which providers must list prices, while providers choose the other 230. With this data becoming public, providers should expect downward pressure on prices — emanating from payers and consumers. To remain competitive, providers must streamline their operations, justify their prices with outcomes data and renegotiate payer contracts to remain competitive. Here is a blueprint that will help in carrying out those objectives:
To ensure pricing remains appropriate in their market, providers must have analytical tools that periodically scan publicly available competitive pricing information. These insights will be critical inputs in annual financial planning and pricing strategy and in considering closures, divestures, and mergers and acquisitions in a provider’s market.
Pricing transparency is here to stay. The demand from healthcare consumers for enhanced visibility into the actual cost of services before those services are delivered will keep growing. Here is how to get started:
This article was authored by Srivaths Srinivasan, Ruchi Mishra, Kinshuk Kaushik, Basel Basha, Lauren Fung and Michael Tucker of Cognizant’s Healthcare Consulting Practice.