December 11, 2019

Pricing Transparency: We’ve Got Your Road Map for 2020

Matt Perron

It’s that magical time of year when we receive our annual gift from Medicare with the Hospital Outpatient Prospective Payment System (OPPS) final rule. Pricing Transparency is a focus yet again and is the gift that keeps on giving. A link to the final rule can be found here: Hospital Price Transparency Requirements.

The good news is the proposed changes don’t go into effect until January 1st2021, giving you more than a year to get ready. Let me walk you through the key changes and recommendations for how to achieve this in the coming year.

  1. Hospitals must make public standard charges for at least 300 ”Shoppable services” including 70 CMS-Specified and 230 hospital-selected services.
  2. Shoppable services must be viewable in a patient friendly format and must be accessible via the internet.
  3. The services must be prominently displayed on the hospital’s website and accessible to the public without charge and without having to register or establish a user account or password.

At first glance this certainly seems daunting. If you are doing estimates in Epic or with another vendor though, you are well on your way. Estimate templates are utilized to identify your most common procedures and will likely contain a lot of the info you are required to share. Also, if you are doing patient facing estimates in MyChart or a different portal, you may already be on the path to fulfilling part of this requirement of making it accessible to patients. If you haven’t discussed Estimate templates or are currently implementing them, this rule will at least provide a bit of a roadmap on where you should build templates and how many you should create. The 70 CMS specific services have not been identified yet but would be an obvious starting spot for any estimate templates you would create.

As for sharing those on your website without a user account or password, that could require some additional planning or even looking at additional tools to help. The sooner you can understand how you may be able to do that the better, especially if that means looking at a different vendor. Starting this planning now also allows you to potentially roll out some of these changes in smaller numbers instead of doing all 300 at once. This could be helpful for you in terms of identifying issues, but also will help prepare your patients for being able to shop for procedures, something that is moving from a differentiator to an expectation for price-conscious consumers.

If you could use help developing a plan and executing the changes in 2020, we’d love to help. At The Wilshire Group we developed a Pricing Transparency Quick HIT offering-a short-term, fixed-price, focused project with immediate results and quantifiable return on investment. Our team of Epic and industry experts can help you optimize your use of Epic, build out estimates, increase front-end collections, and improve your patient’s financial experience. If you would like to learn more about our Pricing Transparency Quick HIT project, please reach out to Matt Perron and Andrew Wade.

Matt Perron

Manager, Patient Access

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