Revenue Cycle Leaders Experience Price Transparency Rule Burden

The majority of revenue cycle leaders were dissatisfied with aspects of the CMS hospital price transparency rule and expressed doubt about the regulation’s efficacy, according to a KLAS report RevCycleIntelligence received by email.

The CMS price transparency rule went into effect on January 1, 2021 and requires all hospitals to publish pricing estimates online for at least 300 shoppable services.

KLAS surveyed 66 revenue cycle leaders over the last year to gauge how hospitals are responding to the rule.

While most respondents said that the price transparency regulation supports a consumer-focused shift in the healthcare industry by allowing consumers to control their own healthcare costs, many leaders were unsure about the rule’s efficacy.

Almost half of the respondents reported that the rule would have a moderate or significant improvement on patient financial outcomes. However, more than half of leaders who felt this way said that the existing regulation needs additional clarification and federal guidance.

For example, respondents expressed concerns about cost, data accuracy, and patient ability to use the pricing tools. Some revenue cycle leaders worried that patients would not be able to understand the pricing data that hospitals display. In addition, patients are frequently unaware that online pricing information for hospital services exists.

Meanwhile, 26 revenue cycle leaders believed that the price transparency rule will have no improvement on patient financial outcomes, and seven respondents reported they think the regulation will hurt patient finances.

Complying with the rule has been a struggle for many hospitals. Most hospitals comply only to avoid monetary penalties, the report noted. Additionally, many organizations said they would not invest beyond the minimum requirements until there is more clarity around the regulation.

Thirty-four revenue cycle leaders responded that the top challenge in achieving compliance was navigating the confusing and complex regulations. Several leaders said that their organizations had to turn to outside consulting groups for help navigating the requirements.

The second most common challenge was insufficient resources.

Revenue cycle leaders were dissatisfied with the requirements to use machine-readable files and to publish a master list of rates online. They cited difficulties with the software used to publish the pricing information.

The software and other resources required for compliance have increased the financial burden for hospitals, respondents said. More than half of the respondents reported that price transparency compliance will continue to require a significant number of resources. Four in ten respondents said that it will require a moderate amount of resources.

Revenue cycle leaders said that in addition to the initial software requirements for price transparency compliance, the individual templates needed for every service that requires a price estimate would increase their burden.

Organizations have struggled to invest in acquiring adequate resources to help with compliance because the regulation does not provide a return on investment.

The report found that hospitals are more likely to turn to third-party solutions for help with price transparency compliance rather than using their electronic health record (EHR) vendor.

Over a third of respondents (36 percent) said that third-party vendors are best positioned to lead in price transparency, while 28 percent said the same for EHR vendors. Satisfaction rates were also higher for those who used third-party technologies rather than their EHR vendor.

However, some respondents said they would consider using their EHR vendor’s platforms in the future for price transparency compliance to help consolidate systems.

According to industry leaders, hospitals can achieve price transparency compliance by using price estimator tools, leveraging the digital front door, and assembling a solid team of staff members.

However, even after the rule has been in effect for more than a year, health systems are still failing to meet the rule requirements.

A February 2022 report from PatientRightsAdvocate.org revealed that less than 20 percent of hospitals complied with the price transparency rule.

Manatt Health found that compliance was lower for the machine-readable file requirement than for the shoppable services requirement.