Price Transparency Beyond the New Regulation
Jase DuRardChief 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 TransparencyDeadline: 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 age40 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 costEnable payment on the front end
When do they owe
Payment plan management
How do they payOmnichannel 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
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