Price Transparency Beyond the New jdurard@accuregsoftware.com . Title: Price Transparency Beyond the

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Text of Price Transparency Beyond the New jdurard@accuregsoftware.com . Title: Price Transparency Beyond the

  • Price Transparency Beyond the New Regulation

  • Jase DuRard Chief Revenue Officer, AccuReg

  • Agenda

    • Update on the final rule

    • Pending payer regulation and potential impact

    • Responding to patients, not just regulations

    • Consequences of the status quo

    • How to solve for price transparency beyond the final rule

  • New Regulations

    November 15: Trump Administration Announces Two Regulations

    • Price Transparency Final Rule – Providers

    2020 Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) Price Transparency Requirements for Hospitals to Make Standard Charges Public Final Rule

    • Transparency in Coverage Proposed Rule – Payers

    December 4: Hospital Groups File Lawsuit to Block Final Rule

    • Plaintiffs include the American Hospital Association (AHA)

    • Seen as violation of First Amendment by hospital groups

  • Polling Question 1

    Is your hospital ready to comply with the Price Transparency Final Rule by January 2021?

  • The Final Rule | Price Transparency Deadline: January 2021

    Comprehensive Machine-Readable File

    • Gross charges

    • Payer-specific negotiated charges

    • Amount hospital will accept in cash

    • Min. and max. negotiated charges

    • Single data file that can be read by other computer systems

    • Common billing or accounting codes used by hospital

    Consumer-Friendly Shoppable Services

    • 300 “shoppable” services

    • 70 CMS required, 230 hospital discretion

    • Grouped with common ancillary services

    • Min. and max. negotiated charges

    • Payer-specific negotiated charges

    • Amount hospital will accept in cash

    • Public, easily-accessible and without barriers

    • Uses “plain language”

    • Updated at least annually

    accuregsoftware.com/solving-price-transparency

  • Compliance | CMS Enforcement

    • Monitoring

    • Auditing

    • Corrective action plans

    • Civil monetary penalties of $300 per day

    $109,500, annualized!

  • Transparency in Coverage | Proposed Rule

    • Real-time, estimate of out-of-pocket costs for ALL services

    • Post negotiated rates for ALL in-network providers

    • Post allowed amounts for ALL out-of-network providers

    Proposed Health Plan Requirements

    • Enable consumers to “shop” and compare costs

    • Drive price-conscious decision-making

    • Promote competition in the healthcare industry

    • Encourage payers to offer new or different plans allowing for "shared savings" payments in their medical loss ratio (MLR) calculations

    Ideal Results

  • What Actually Matters to the Patient

    • Price of complete service

    • Specific medical benefits

    • Deductible remaining

    • Service-specific copays

    • Co-insurance percentage

    Out-of-Pocket Costs

  • Responding to Patients,

    Not Just Regulations

    Access to trustworthy, transparent cost information

    Easily accessible digital technology

    To make better-informed healthcare decisions

  • Solving for Patient Price Transparency

    NEGOTIATED PRICE FOR SERVICE

    CHARGES FOR SERVICES CUSTOMARILY PROVIDED

    IN CONJUNCTION WITH THE PRIMARY SERVICE

    PATIENT BENEFIT COVERAGE AND

    RATE

    PATIENT DEDUCTIBLE AND

    REMAINING BALANCE

    CO-INSURANCE IMPACT ON THE AMOUNT THE

    PATIENT WILL OWE

    INSIGHT INTO FUTURE COSTS

    To empower patients to be “shoppers,” you must provide:

  • Patients Want Insight into Future CostsPrice Transparency for Patients = Estimated Out-of-Pocket Costs

  • Only 9% of the collective providers reported the ability to offer these consumer demands successfully*

    * Black Book Market Research

    • Online payment options

    • Price transparency

    • Virtual access points

    • Online scheduling

    9%

  • Polling Question 2

    Does your hospital offer digital engagement points, such as online scheduling, online payments and price transparency?

  • 90% of patients no longer feel obligated to stay with healthcare providers that don’t deliver an overall satisfactory digital experience.

    Consequences of the Status Quo, Beyond Compliance

    Delay healthcare treatment

    Forego healthcare treatment

    Seek healthcare from your competitor

    * Black Book Market Research

  • * NRC Health

    75% of consumers consider their healthcare decisions as the most important and expensive decisions they make.

    Yet, the process of choosing and paying for medical services can be so daunting that patients often decline treatment simply to avoid the confusion and expense.

    Consequences of the Status Quo, Beyond Compliance

  • A New Age of Patients

    *Pew Research Center

  • Powerful Consumers • Account for 30% of total consumer spending • Make up only a quarter of the population

    Highly Educated • Make purchase decisions for other generations

    living in their households, aging Baby Boomer parents and Gen Z kids

    Top Online Purchasers • 20% more than millennials • Purchases start with online research/reviews • Focus on value and performance

    Who is Generation X? 1965-1980

    (38-53 years old)

  • Smartphone Generation • Most likely to purchase on smartphones • Use online portals and apps

    Omnichannel Experience • Researching and purchasing online • 68% seeking consistent experience across channels • Expect ease and accessibility

    Influenced by Peers • 82% say word-of-mouth influences purchase decisions • Use personal relationships to establish brand loyalty

    Who are Millennials (Gen Y)? 1981-1996

    (22-37 years old)

  • 88% of people under age 40 say they will choose

    their next medical provider based on a

    strong online presence.

    * Black Book Market Research

  • Benefit coverage + out of pocket costs

    Understand total cost Enable payment on the front end

    When do they owe

    Payment plan management

    How do they pay Omnichannel experience

    Access across channels

    Address Consumer Pain Points

  • Mobile and Web! Provide actual price

    transparency! Get paid faster, in-full

    and before POS!

    Provide a Digital Healthcare Experience, that Pays!

    Meet consumers wherever they are

    Enable patients to shop and pay for services online

    Start the conversation about

    payment

  • Patient-Facing Estimator

    Enables your hospital to empower patients with self-service estimates

    Generates real-time out-of-pocket:

    • Self-pay estimates

    • Prices estimates for services, using insurance

    • Includes all key components of what the patient will actually owe

  • Patient-Facing Estimator

  • Prepare for Peace of Mind

    • Simplify compliance for your hospital

    • Reduce operations burden

    • Avoid penalties for compliance violations

  • Polling Question 3

    Does your hospital offer patients an online, self-service cost estimation tool?

  • Increase POS collections

    Drive higher net revenue

    Improve patient satisfaction

    Meet compliance requirements

    Drive patients to your door!!

    The Benefits of Providing Price Transparency

  • Chief Revenue Officer

    Jase DuRard

    615.438.5273

    jdurard@accuregsoftware.com

    www.accuregsoftware.com