Page 9 - SFHN March 2021

Reaching Compliance: The CMS Price Transparency Rule

As we head into 2021, standard charges, except tive implications beyond the healthcare Providers can go beyond compliance
healthcare providers must gross charges, for at least industry. Second, past studies have with the rule to differentiate themselves
confront the CMS’s new rule 300 “shoppable” services demonstrated that consumers rarely from their competitors by creating a
on price transparency. This • 70 of these shoppable access pricing information to choose holistic digital shopping experience for
rule, while intended to help services will be deter- their provider or services, even when it is their consumers. By taking lessons from
consumers better compare mined by CMS readily available. Third, the rule could industries like retail, banking and hospi-
prices across providers, will • 230 of these shop- complicate payer-provider relationships tality, providers can design an experience
require significant resources pable services will be and managed care contracts, which pro- that improves patient satisfaction, lead-
for healthcare organizations determined by the vide financial stability and increased rev- ing to increases in HCAHPS scores and
to reach compliance at a time provider enue for providers. Finally, providers STAR ratings. Creating a platform that
when COVID-19 is already • Providers must dis- claim that compliance with the rule is provides consumers with clear and use-
straining the system. close five types of “stan- overly burdensome given the strain ful information will keep them coming
Despite the challenges, the BY VENSON WALLIN dard charges”: many health systems and hospitals are back and build consumer loyalty.
rule also presents providers 1. Gross charges already feeling due to COVID-19. Complying with the CMS rule will be a
with an opportunity to dif- 2. Payer-specific nego- It is unlikely that the result of the difficult lift for providers, especially in
ferentiate themselves from competitors tiated charges appeal will be revealed prior to the the COVID-19 context. However, there
and capture more market share. Before 3. Discounted cash prices January deadline. It is similarly unlikely are opportunities to leverage this rule to
providers can capitalize on strategic 4. De-identified minimum negotiated that there will be a delay in implementa- improve the patient experience and cap-
advantages, it’s crucial to understand charges tion of the rule—although the AHA has ture more market share. Providers
what’s required. 5. De-identified maximum negotiated asked for a delay, the slow transition should consider their wider goals beyond
charges process to a new presidential administra- price transparency compliance before
Understanding the Rule tion and the necessity of prioritizing a choosing how to design their online
Background Exemptions pandemic response mean the issue is experience in order to optimize the ROI
Price transparency has been a topic of Hospitals that have a price estimator unlikely to receive attention in the near of their tool.
debate for decades. With the passage of tool may be exempt from the require- future. Need help creating a tool that lever-
the Affordable Care Act, price trans- ment to publish a consumer-friendly list As such, it is prudent for providers to ages price transparency to the fullest?
parency took its first step forward, with of shoppable services. assume the ruling will remain in place in Reach out for details on how BDO can
hospitals required to post list prices for its current iteration and begin preparing help.
all services provided. The current itera- Penalty for compliance immediately.
tion of the CMS rule originated from The maximum fine for noncompliance Venson Wallin is
President Trump’s Executive Order on is $300 per day. Additionally, noncompli- Compliance and Beyond Managing Director, BDO.
Improving Price and Quality ant entities could lose their Medicare Complying with the rule will take sig-
Transparency in American Healthcare to accreditation—this may prove to be a nificant time, energy and resources. For Contact:
Put Patients First, issued on June 24, much stronger deterrent for noncompli- providers, it may be prudent to seek help Alfredo Cepero, Managing Partner
2019. ance than a fine. from an external firm that specializes in 305-420-8006/ acepero@bdo.com
the healthcare industry and technology.
Requirements Response to the Rule Providers can leverage their expertise Angelo Pirozzi, Partner
The CMS rule applies to most licensed The American Hospital Association and access to resources to reach compli- 646-520-2870 / apirozzi@bdo.com
hospitals, who must fulfill the following (AHA) filed a suit challenging the rule ance as efficiently as possible.
requirements: on the basis that the Department of
• Providers must be compliant with Health and Human Services (HHS) does
the CMS rule by January 1, 2021 not have the authority to implement it.
• Providers must release all privately Although the rule was upheld in the U.S.
negotiated reimbursement rates District Court for the District of
• The charges must be published in Columbia, the AHA has already filed an
two formats: appeal.
1. A machine-readable file that Providers and health systems have
includes all standard charges for all items levied a number of criticisms against the
and services by physician and non-physi- rule. First, providers believe that the
cian practitioners employed by the hos- negotiated prices are proprietary infor-
pital mation in the industry—the government
2. A “consumer-friendly” display of all mandating their reveal could have nega-

Palm Beach Health Network

Announces Safe, Virtual Visits

to Its Emergency Departments

Via Tele-ER Option

The Palm Beach Health Network will now be offering patients a new option for
care with Tele-ER. This option allows anyone to talk to a board-certified
Emergency Room physician 24 hours a day, seven days a week. All you need is a
smartphone, tablet or computer. Patients who may be uncertain whether to seek
treatment or go to the hospital, no longer have to make the decision alone thanks
to Tele-ER. “As the healthcare provider of choice, the Palm Beach Health
Network is continually evolving to better serve our community. We are excited to
announce the launch of Tele-ER at two of our hospital locations, Coconut Creek
and Lake Worth. Patients will be able to make direct contact with an Emergency
healthcare provider from the comfort of their own home,” said Maggie Gill, chief
executive officer of the Palm Beach Health Network. “Tele-ER provides a new
solution for convenient access to care. If your condition requires a visit to the
emergency department, please know we are safe, equipped and ready.

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