Wind River was thrilled to welcome the members of the Healthcare Advisory Board for the first meeting of 2019. The Healthcare Advisory Board was put together as an opportunity for revenue cycle leaders, healthcare payment experts, healthcare product partners and Wind River’s healthcare team to come together and discuss key topics around the industry. The goal is for everyone to share best practices and innovative solutions amongst each other.

This month’s leading topic was price transparency for patients. Jeffrey Remsik from Bottom Line Marketing joined the meeting to share his insights on the newest rule from the Centers for Medicare & Medicaid Services (CMS) regarding hospital prices and the impact. Here’s a quick recap of the discussion:

What does price transparency mean?

  • Price transparency can be defined in different ways, but one of the ultimate goals is to provide “increased clarity for patients when reviewing their costs or bills.”
  • In the pre-service area, some providers are posting prices online for patients to see or providing estimates for an upcoming procedure.
  • On the post-service side, some providers are providing clear payment plans for a patient’s entire bill or offering bundled payments for multiple services.
  • As patients continue to pay more out of pocket with high deductible health plans, organizations that provide a clearer picture for patients’ bills will have a distinct advantage in gaining patient trust.

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What is CMS doing now and in the future?

  • As of January 1, 2019, CMS is requiring (without any noncompliance penalties) all hospitals in the United States to “make public a list of their standard charges.”
  • The general understanding at the meeting and across the industry is two-fold.
    • Price transparency is a step in the right direction toward empowering patients.
    • Without additional information or enforcement, it likely won’t have an immediate effect in the short-term.
  • Though January’s rule was a relatively small change, it’s anticipated that additional rules and enforcements will be established in the coming years. Organizations would do well to get ahead of these changes and proactively plan for ways to provide clear and understandable price lists to their patients.

What can organizations do to enable price transparency now and in the future?

  • Currently, the vast majority of organizations that have something in place for price transparency either rely on manual, labor-intensive processes or static, rules-based solutions. The challenges for those two processes, respectively, are:
    • They take too long to produce accurate results.
    • They can’t change over time to capture changes in patient profiles.
  • Increased clarity for patients also means delivering accurate information sooner; a task neither of the processes mentioned can tackle easily
  • In an effort to provide a better financial experience for patients, organizations should look to utilize solutions that can give patients highly accurate estimates early, which means approaching the problem differently.
  • Solutions leveraging machine learning and AI have proven to be more accurate at predicting costs based on a multitude of variables. They are flexible, adapt over time and learn to use new factors without manual intervention.

Our next Healthcare Advisory Board meeting is tentatively scheduled for mid-May. As always, if you’re interested in participating, please reach out and let us know. We’re always on the lookout for new members to join us for a little industry knowledge share. We’d love to have you.