Dr. Chandra Bondugula (ZeaMed Founder and CEO) was the moderator at the Alabama Healthcare Executive Forum’s webinar on price transparency. He asked Dawn Bulgarella, CFO of UAB Health System, and William Horton from Jones Walker LLP. They are talking about the new CMS price transparency law that is supposed to go into effect on January 1, 2021.
Watch it here: Webinar on CMS Price Transparency Requirements
The recent price transparency rule has created upcoming challenges for hospitals and their billing practices. Although this is a new, specific rule, the concept goes back as far as 2006, when the CMS (Centers for Medicare & Medicaid Services) began publishing prices. In 2006, 100 common procedures were listed, but the way it was given was found to be too confusing for people who didn’t have a medical background. It was hard for them to find the pricing they were searching for.
The 2019 rule has added two very important criteria to the listings of pricing and rates for common procedures:
- It must be a machine-readable list (“data in a format that can be easily processed by a computer without human intervention while ensuring no semantic meaning is lost.” Source: OPEN Government Data Act, January 2019)
- It must be consumer-friendly and include a web-based estimator tool that doesn’t have identifiers required to access it.
Benefits of this rule primarily apply to the underinsured or those with high deductible plans. Although there are going to be many who will find better healthcare because of these rules, it’s still a challenge for many patients for these reasons:
-Some people don’t want to shop around because it creates more work and takes more time.
-Some aren’t as concerned with prices but would like to find a provider near their location.
Overall, hospitals also face challenges with setting up this system (such as manpower required to maintain it, bandwidth to manage the internet and IT needs, and having to list multiple rates and situations for each case), but it will incentivize providers to provide better and more affordable care. It will also incentivize patients to be better and more informed consumers of healthcare.
One way to prepare for what may be upcoming changes in the healthcare world is to learn how to price compare for your own healthcare needs right now, using tools like Zeatool. Zeatool is one-way hospitals can make their information compliant with CMS, by creating a seamless way for people to shop and price compares common procedures.
If you’re a hospital administrator and are interested in using ZeaTool for your healthcare needs, check us out at ZeaTool.com