6 opportunities health systems face due to price transparency

The CMS price transparency rule that took effect Jan. 1 is presenting new competitive opportunities for health systems, according to research released April 9 by actuarial firm Milliman.

The CMS final rule aims to make hospital-pricing information readily available to patients to compare costs and make more informed healthcare decisions. To aid with this, hospitals in the U.S. are required to post both a machine-readable file with the negotiated rates for all items and services and display the prices of 300 shoppable services in a consumer-friendly format. 

Milliman reviewed price transparency postings from 55 health systems in 42 states between Jan. 1 and March 3. It looked at their file formats and the ease of retrieving data, whether they posted negotiated rates and whether they posted all data required by CMS.

They found 68 percent of health systems had posted at least one machine-readable file listing gross charges, discounted cash prices, payer-specific negotiated rates and deidentified maximum and minimum charges by item/service. Twenty-one percent had posted  payer-agnostic standard charges only; 9 percent posted  payer-specific negotiated rates; and 2 percent had not posted any files at all.

Below are six potential competitive opportunities brought about by price transparency, according to the report:

  1. Automation of the collection of current and historical payer rates to identify trends

  2. Analysis of market position compared to competing providers and payers

  3. Comparison of providers' weighted average reimbursement based on utilization distribution and payer mix

  4. Development of direct-to-provider contracts for employers

  5. Identification of the financial effect of network types and supporting negotiations

  6. Aid for healthcare consumers to better understand the cost of care

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