As we mentioned in our previous post在美国,CMS已经实施了2024年额外的医院价格透明度要求. With these new requirements, CMS通过要求披露更多信息,表明了其对价格透明度的重视, standardizing data formats to facilitate aggregation by third parties, and stepping up its oversight and enforcement efforts.
For hospitals already struggling with resource constraints, these new requirements may come as an unwelcome burden, 而且,尽可能少地做一些工作来遵守这些规则,这是很诱人的. However, 医院如果能接受这些要求,并充分利用价格透明带来的信息,就会做得很好.
Overview of the New Rules
The CY 2024 rule contains quite a few changes, which pertain primarily to the machine-readable, 所有标准价格的综合文件(而不是单独列出300项“可购物云顶集团”). Changes include the following:
- Reporting features to facilitate data aggregation across hospitals
CMS显然打算促进第三方对医院数据的汇总,这些第三方将打包这些信息并向公众发布. Effective January 1, 医院现在被要求在他们的网站上包含内容,帮助用户导航到全面的机器可读文件. Beginning in July, 这些文件还必须包括识别其包含数据的医院的信息, 大概是为了让数据聚合器不必自己提供这些数据. Additionally, CMS has become much more prescriptive in the format of these data files, 同样,其明显目的是创建标准化,以促进聚合.
- Descriptions of payment methodologies
Beginning in July, 医院需要将这些信息表示为费用的百分比或其他适用的算法, along with the historical amount paid for those services. 实际上,这允许第三方重建付款人的付款方法.
- Attestations from hospital executives
医院的指定代表需要提供一份证明,证明机器可读文件中包含的所有信息都是完整和准确的. CMS认为,这将使他们能够更好地执行问责制,并解决有关提交数据的任何悬而未决的问题.
- Increased enforcement
CMS现在保留对医院的标准收费信息进行全面合规审查并公布审查结果的权利, 以及针对医院采取的任何合规行动以及发送给云顶集团40011官网领导层的任何通知. These steps are in addition to the audits that CMS currently performs, 自该计划首次实施以来,哪些项目的数量显著增加.
What Hospitals Should Do
鉴于价格透明度要求自三年前出台以来变得更加严格, 在可预见的未来,它们似乎不太可能放松. As such, 医院应该认真考虑如何利用向公众提供的信息. We offer some suggestions below.
- Make sure your hospital is compliant.
首先,不要因为未能满足这些要求而成为CMS的焦点. The industry has generally been slow to embrace price transparency, 这可能解释了为什么CMS正在加强监控,并对那些没有采取必要纠正措施的公司施加更严厉的惩罚. Additionally, by posting letters of noncompliance on its website, CMS is exposing hospital executives to public scrutiny and shaming.
- Prepare to spend time reviewing contract language.
因为CMS要求机器可读的文件包含计算付款的方法, 医院将需要汇编这些信息,并将其纳入其综合价格档案. 在某些情况下,医院可能不得不创建与付款人方法的外部描述的链接. Performing this function requires expertise in payer contracting, 哪些可能超出了以前负责发布医院价格透明度信息的内部员工和外部供应商的范围.
- Use price transparency as an opportunity to assess your payer strategy.
Hospitals are required to refresh their pricing information annually, which presents an opportunity to assess their payer strategies. By conducting the refresh, hospitals must compile their own pricing information at a detailed level; having accomplished this, 然后,他们可以利用数量不断扩大的市场数据源,轻松地将自己的信息与竞争对手和同行的信息进行比较.
进行这种审查将有助于医院考虑如何战略性地为其云顶集团定价. It may no longer make sense to seek across-the-board rate increases; instead, 医院将需要确定哪些云顶集团是定价具有竞争力的商品,哪些是差异化的商品, allowing the hospital to command a premium price.
- Take advantage of market data in payer negotiations.
市场定价数据的可用性可以对医院与付款人协商费率的能力产生巨大影响. 当我们帮助客户签订付款合同时,我们已经在使用这些数据了, 因为它消除了大部分的信息差距,这是支付者历来使用的优势. As the data becomes more robust and its reliability increases, 这将被证明是医院谈判策略中不可或缺的组成部分.
有趣的是,我们的价格透明度法规是现任和前任总统政府工作的产物. The concept has broad appeal because for decades, 当病人试图了解他们的医疗费用时,他们在很大程度上被蒙在鼓里. Similarly, 传统上,医院和其他医疗云顶集团提供者几乎不知道自己的价格与同行相比如何. That is changing rapidly, 而那些考虑过如何应对这种增加的可见性的供应商将最有可能取得成功.
Is Your Organization Ready for the Increased Visibility?
Edited by: Matt Maslin
Published February 8, 2024