How to meet your patient's price transparency expectations — 5 takeaways

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With an ever-growing portion of healthcare costs falling on patients, regulations that aim to increase price transparency and rein in surprise billing have spurred healthcare organizations to assess compliance specifications and rethink the patient experience. 

During an October webinar hosted by Becker's Hospital Review and sponsored by RevSpring, Howard Bright, vice president of patient engagement at RevSpring, discussed the price transparency regulation and No Surprises Act. He said providers should view this moment as an opportunity to strengthen patient engagement rather than merely comply.

Five takeaways: 

1.) Patients' responsibilities and expectations are changing. Patient responsibility for payment has increased and patient behavior continues to change, as patients want to be treated like consumers. "They [patients] are basically the new payer," Mr. Bright said.

In light of these changes, providers want to deliver a smooth, connected experience. To build such an experience, providers may bring key patient-facing functions under one roof, such as hospital admissions, clinical care and billing. 

2.) Limitations to out-of-network cost sharing bring patients peace of mind. The No Surprises Act prohibits balance billing by out-of-network providers, which must treat all patients as if they were in-network unless the patient explicitly agrees otherwise. In emergency scenarios, providers are prohibited from requiring prior authorization, which represents a major relief for patients who typically have no control over the services they receive or the price. 

3.) Disclosures, notifications, estimates of charges and prior consent requirements are patient engagement opportunities in disguise. These communications, which preserve the right of out-of-network providers to deliver services and charge higher fees, must be displayed as signs in providers' facilities, on websites and in writing or electronic form to patients within specified time periods. 

Although this may seem heavy-handed, it improves trust, patient loyalty and transparency. "If you have a great patient engagement strategy already, these patient notifications can roll right in there with it," Mr. Bright said. "You can use them as an informational tool and a patient satisfaction tool." 

4.) Hospitals that publish payer-specific charges in plain language have a leg up. Price transparency regulation mandates providers publish pricing information, including payer-specific negotiated charges on 300 services. Providing this information allows patients to know what a health service will cost them specifically under their insurance policy. However, to date most hospitals are not complying or are doing so only partially. This creates an opportunity for hospitals providing price information and user-friendly estimates to stand out, Mr. Bright said. "This is an opportunity for hospitals to lean in and say, 'How can I use this ruling to make it a gain instead of a negative?'"

Starting next year payers will also have to publish their negotiated rates with providers. This is expected to allay concerns about potential differences between estimated payer-specific charges and the eventual bill. "The big takeaway is that not all estimates are the same, not all patients are the same, and by customizing the actual service to the plan they're in and the patient's situation, you can provide a much more effective patient engagement experience," Mr. Bright explained. 

5.) Price estimates and "shoppable" service lists open the door to patient experience excellence. Hospitals are encouraged to go beyond simply complying with these transparency requirements by creating interactive websites that mimic the retail experience, where patients can select a service, get a personalized price estimate and schedule an appointment all at once. Being creative around price transparency legislation "opens up so many other avenues," Mr. Bright said.

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