Price Transparency

In this blog, we identify emerging healthcare payment predictions and trends heading into 2022. Is your organization ready?

Dan Wiens, Product Director for Patient Estimates at Experian Health, discusses the future of patient estimates and healthcare price transparency.

In this infographic, we break down the changes to post-COVID-19 patient journey, and the changes that have impacted every step.

The No Surprises Act, effective January 1st 2022, aims to protect patients from receiving surprise medical bills. Read our blog to learn more.

Learn about COVID-19’s impact on the patient journey and see how digital transformation is helping the healthcare industry recover.

The State of Patient Access surveys patients and providers to see how patient access has changed since COVID-19. See the results!

The pandemic dominated healthcare in 2020, but it won’t be recognized as a reason to delay complying with CMS’ price transparency mandate, which went into effect on Jan. 1, 2021. A recent study conducted by HealthAffairs indicated that 65 of the 100 largest hospitals in America had not complied as of February 2021. And new reports from CMS suggest $300 daily fines will follow if CMS warning letters have no impact, in addition to the possible public exposure of facilities failing to be compliant. There are a number of reasons why price transparency has generated so much attention – both before and during the COVID pandemic. Consumer advocates point to other transactional experiences, such as auto and home purchases, where understanding the price is complicated, but achieved. There’s been a lot of research on price transparency’s impact on patients, as well; helping consumers understand healthcare billing reduces the stress of their financial experiences. Transparent pricing makes sense in many cases for providers, too. They may benefit from patients being able to plan for the costs of care, which can result in fewer missed payments and write-offs. For these reasons and others, price transparency has been a hot topic for the last few years. The Centers for Medicare and Medicaid Services (CMS) final rule on price transparency became effective on January 1, 2021, requiring hospitals to give patients clear information about their medical costs, including a list of charges for the hospital’s 300 most shoppable services, so patients can make informed decisions. Payers are expected to provide similar pricing information beginning January 1, 2022. The spotlight on healthcare pricing seems unlikely to dim any time soon. What does this mean for providers and payers? Price transparency is here to stay There were legal challenges made against the price transparency final rule, questioning federal authority and invoking constitutional rights violations, but the DC Circuit Court dismissed the claims in December 2020. Arguments against the current mandate are not limited to disputing legal authority, suggesting that government should not interfere with private sector pricing – and that complex pricing information could create the opposite effect of confusing consumers. In fact, many providers and payers voice support for price transparency, but not as put forward by the final rule. Despite this, consumer demand for pricing clarity before delivery of services continues to grow and current government regulation is the most far-reaching attempt so far to remedy this. A few state legislatures are moving forward with their own regulations, which could prompt more local collaborations between providers and payers to clarify out-of-pocket cost estimates. Achieving the level of transparency that CMS and consumer groups hope for will be challenging, but attempts to find common ground are growing. What will price transparency look like under the Biden Administration? Since President Biden entered the White House, the trend towards transparent pricing has continued. Provider compliance has been slow – many pointing to 12 months of battling COVID as the primary reason – prompting legislative pressure to step up audits and penalties. CMS has already started issuing noncompliance warning letters and, while it may modify the ruling under a new administration, there’s no sign of any plans to reverse the policy. Consumer action groups have voiced concerns that the regulation falls short, citing the difficulty a consumer may have trying to find pricing at provider web sites. Other consumers are limited to payer-negotiated rates and have little choice but to stick with their current providers. Making information available is likely an early step toward what price transparency will ultimately look like, but making that information easy to find, understand and act on is what consumers value – and what many providers and payers say they want to provide in a more customized, less one-size-fits-all application. A marketing strategy for price transparency As patients bear more responsibility for healthcare costs, they’ve come to expect a consumer experience that affords them greater control and choice. A Pioneer Institute study found that 70% of healthcare consumers want to see pricing information before undergoing a medical procedure. Actively communicating a commitment to price transparency can be a powerful marketing strategy to attract and retain loyal consumers. Not surprisingly, this messaging resonates more with user-friendly tools to guide patients through their financial journey and make sense of charges. Many providers believe they’re complying with the final rule but may actually be vulnerable to penalties because their pricing files are in user-unfriendly formats. A web-based pricing tool can help solve for this by offering patients accurate estimates and recommended payment plans before or at the point of service. Similarly, a text-to-mobile tool, such as Patient Financial Advisor, can send automated text messages to patients with personalized estimates and bills. Keeping an eye on healthcare price transparency More tools are now available to help patients make sense of their billing and it’s becoming easier for providers and payers to create a patient financial experience that’s supportive from the start. Not only will this help patients understand their cost of care (and with that understanding likely comes better collections performance), it’ll help reduce the risk of uncompensated care ¬– and avoid penalties as the final rule takes root. The Biden Administration’s focus on consumer-friendly healthcare services will likely keep price transparency at the forefront. What that looks like over the next few years depends on regulatory and market forces, but providers and payers alike will benefit from offering solutions that make sense for their organizations and patient populations. Find out how Experian Health’s price transparency tools could help your organization with the transition.

Will handshakes become a thing of the past? Will face masks become a regular feature of flu season? Will home-working remain popular, even after workplaces re-open? COVID-19 forced some abrupt behavior changes that challenged existing cultural norms, but as the pandemic subsides, how many of these adaptations will survive?   For healthcare executives, the return to on-site medical visits raises similar questions. Healthcare consumers were already expressing an appetite for more convenience and control, and the pandemic accelerated the use of digital solutions for everything from patient access to telehealth. Being able to book appointments, complete pre-registration forms and make payments online is the new baseline.   As patient volumes start to increase, hospitals and physician groups shouldn’t take their foot off the gas with digitalization, particularly in patient intake, which doesn’t have to involve in-person contact. There’s an opportunity now to learn from what’s worked well over the last year and cement the pandemic’s digital legacy.   What does the new normal look like in patient intake? Getting back to basics with convenience and compassion Once crisis mode has passed, providers can refocus their efforts on the building blocks of an optimal health service: high quality care and a convenient and compassionate patient experience. After the uncertainty and loss of control over the last year, patients want autonomy and choice. Initiating a smooth patient journey through online pre-registration, patient portals, virtual waiting rooms and digital scheduling can contribute to this.   Many will be happy to say goodbye to piles of paper forms and long waits in the waiting room. But any digital strategy must also support those with limited access to devices and broadband or limited digital literacy. Liz Serie, Director of Product Management at Experian Health, says:   “The goal is to give patients the same exceptional experience and care, regardless of when or how they complete patient intake. Using the same tools that we know our patients are already comfortable with will help to ensure an inclusive approach.”   Digital technology can support a multichannel approach, for example, using automated dialers to make phone calls where mobile apps aren’t an option, or using patient data to segment individuals according to contact preferences. Re-engaging hesitant patients The CDC reported in September 2020 that around 40% of adults delayed care due to the pandemic. While more recent data suggests fewer patients are deferring care, some experts worry that patient volumes won’t return to normal until 2022. How can providers ease the return to care?   Online health portals were helpful in keeping people out of facilities during the pandemic – can they now serve a different purpose in reminding patients to come in for check-ups?   Patients will need clear information about what protocols to follow during patient intake and what to expect from virtual waiting rooms, as well as reassurance that the experience will be safe. Streamlining patient access with accurate data Unlocking the digital front door made logistical sense during the pandemic. It’s even more critical as patient volumes drive back up. Providers will want to review their protocols to be sure that speedy implementation has not left that door open to costly data errors. Is the right information being collected at the right time?   Consumers are looking for flexible and accurate appointment slots for self-scheduling, and they want their financial ducks in a row as soon as possible with quick authorizations and coverage checks. Getting data right first time makes for a smoother patient experience, more efficient staff workflows and fewer claim denials down the line. Preparing for an uncertain future Looking ahead, patient intake protocols will need to be flexible enough to adapt to changing patient needs, particularly if there are further waves of the pandemic. Digital solutions can help providers prepare for the unexpected and shift from a reactive response in a crisis to a proactive step towards the future.   For many providers, future-proofing the patient intake experience is also an important remedy to the financial losses suffered during the pandemic. Digital solutions built on accurate data, consumer needs, accessible information can protect against further revenue loss by giving patients reliable ways to access and pay for care, no matter what the future holds.   Medicine is built on in-person care, but we don’t need to be face-to-face to fill out forms. Patient intake is one area where “the old way” doesn’t have to return. Find out more about how your organization can build on the pandemic’s digital legacy and create a leading patient intake experience.

Providers know they need to improve their digital front door to withstand the financial impact of COVID-19, but change can feel risky, especially with so much uncertainty. Experian Health’s recent patient access survey offers a glimpse of what patients hope the digital front door will look like in 2021 and beyond. But what do providers see for the future of patient access? And are those views aligned? Providers that offer the most accessible patient access solutions in a post-pandemic world will secure greater patient satisfaction and loyalty.