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3 Hospital Price Transparency Strategies for Compliance, Patients

Hospital price transparency is now a requirement from CMS, but providers should be going beyond the rule to ensure transparency meets patient demands, too.

Jacqueline LaPointe
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Published: 13 Aug 2021

Hospital price transparency goes beyond just compliance with federal regulations. Patients are also demanding more transparent pricing information from their providers in order to make more informed decisions about their healthcare. Unfortunately, many hospitals are failing on both fronts.

A recent report from PatientRightsAdvocate.org found that 94 percent of hospitals were not complying with hospital price transparency requirements from CMS over six months after their implementation. Those requirements include displaying five types of pricing information, including payer-specific negotiated charges, on public websites and displaying prices for at least 300 shoppable services in a consumer-friendly format.

Compliance has been an ongoing challenge for hospitals and the federal government since CMS enforced the rules at the start of 2021, despite the threat of audits and penalties. However, non-compliance may be hurting patients, too.

Three-quarters of patients look at price transparency ahead of accessing care, according to a 2019 survey conducted by TransUnion Healthcare. A more recent poll of consumers also found that patients view the process of accessing care to be a chore. What’s more, 85 percent said comparing healthcare prices should be as easy as price comparisons are for other consumer products and services.

To avoid potential penalties and align processes with consumer demands, hospitals should be focused on complying with hospital price transparency requirements and ensuring their strategies benefit patients.

Use price estimator tools

Hospital price transparency compliance requires time and resources—two things many hospitals don’t have to spare. Hospitals have already reported that it took over 100 hours to comply with a skinny version of the requirements in which hospitals only had to post standard charges in a machine-readable format. Some stakeholders have estimated that the new requirements will take months and perhaps hundreds of thousands of dollars for full compliance.

A strategy for avoiding the manual legwork of hospital price transparency compliance is implementing a price estimator tool.

CMS states that price estimator tools fulfill compliance requirements as long as the tools are internet-based and provide estimates for at least 300 shoppable services with consumers having to register or establish an account or password. Tools must also be prominently displayed on the hospital’s website and allow all healthcare consumers to obtain an estimate of the amount they must pay for the service at the time they use the tool.

Many large hospitals are already using this strategy and those that do use a price estimator tool are more likely to publish payer-specific negotiated rates per CMS requirements, a recent study showed.

Price estimator tools are also easier to use for patients. Without a tool, patients are left to search long lists of pricing information for their planned services, that is, if they have the correct codes for those services. Price estimator tools can streamline the process for patients.

Open the digital front door

The digital front door is trending in healthcare right now. The term refers to a wholly connected patient journey from registration to follow-up care using technology and patient self-service tools. For hospitals, it may also be the starting place for price transparency that caters to patient needs.

Carilion Clinic, for example, has opened this figurative door for patients by enabling price estimate look-up via the patient portal. The organization then has patient navigation through the financial points of a patient’s journey, for instance, having staff on hand to answer calls about price estimates. These touchpoints allow for more upfront conversations about hospital pricing, which is a best practice for meaningful price transparency.

This digital front door goes far beyond compliance with the hospital price transparency requirement, focusing instead on patient needs during the financial experience. And once providers open that door, they should be focusing on creating an exit.

“We've moved to what we like to refer to as the digital back door,” Don Halliwill, executive vice president and chief financial officer at Carilion, recently told RevCycleIntelligence. “Once a patient has made a decision about their care, they've received their care, and they're now dealing with the backend of the process with their financial responsibility, how do we enable that and engage patients at that point in the relationship to try to make it easier on them?”

The digital back door supports meaningful price transparency and other front door initiatives by delivering the same level of attention and automation after a patient leaves the office.

Bring the right team together

Technology and automation are at the heart of the hospital price transparency requirement. However, the people behind those tools are just as important to ongoing compliance and patient satisfaction.

As Carilion’s Halliwill explains, compliance with the new requirement involves a lot of people from across the organization.

“You work on the different aspects of the requirements and you have to test it and then, you find little things that need to be tweaked. So then, you test it again,” the health system leader stated. “Just by, [the rule’s] nature it takes a lot of time and a lot of people involved, from the clinical areas, revenue cycle, contracting to our IT folks and our folks on the media side who helped us with the website.”

Hospitals should bring together people from across the organization to craft a price transparency strategy that benefits patients, fulfills compliance requirements, and just as importantly, helps the hospital.

One area that may be beneficial to achieving all three goals is marketing. A recent Health Affairs study found that marketing a price transparency tool helped to boost utilization. Marketing can also combat one of the greatest challenges of price transparency: limited consumer awareness of price transparency tools and requirements.

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