HHS’ Azar and CMS chief Verma are forcing hospitals to provide transparency. And that’s just the beginning

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When Alex Azar, head of HHS, spoke at the Federation of American Hospitals in March, he wasn’t kidding. It’s happening. The government is forcing providers into consumerism in healthcare.

Azar said in his speech: “The four areas of emphasis are the following: giving consumers greater control over health information through interoperable and accessible health information technology; encouraging transparency from providers and payers; using experimental models in Medicare and Medicaid to drive value and quality throughout the entire system; and removing government burdens that impede this value-based transformation.”[1]

CMS is adding teeth to the talk with its proposed 2019 Inpatient Prospective Payment System rule that will require “hospitals to post a list of their current standard charges online in a machine-readable format by Jan. 1 and to update the information annually.”[2]

The government is stepping in and forcing the issue of consumerism in healthcare. It’s not a matter of “if” anymore, it’s when. And “when” is less than a year away. CMS’ proposed civil monetary penalties will apply to hospitals who refuse to comply. The agency will allow hospitals to use the chargemaster or a form of the hospital’s choice, according to the rule.

This is just the start. According to an article in HealthCareDive, reporters spoke by telephone with CMS chief Seema Verma: “’We are just beginning this,” she said on the call, adding the agency is committed to helping patients have access to cost data.”[3]

Specifics about the rule, include:

HHS asks for input on how the department can encourage hospitals to undertake efforts to provide consumer-friendly communication of what their potential financial liability may be for services provided at the hospitals to enable patients to compare prices between different hospitals.

Specifically, the department is asking stakeholders for input on how to define what the best measure of a “standard charge” is, how CMS can work with third parties to create patient-friendly interfaces with such data, if providers should be required to tell patients how much out-of-pocket costs for services will be prior to receiving care and if providers should be required to inform patients how much Medicare pays for specific services.

CMS is also asking for what enforcement mechanisms would be appropriate to encourage price transparency from hospitals, such as imposing civil money penalties for those that don’t comply.[4]

Seema Verma says the department is asking stakeholders on input: “how CMS can work with third parties to create patient-friendly interfaces with such data.” Therein lies your opportunity. If you opt for the chargemaster, the sticker shock will keep many people from seeking healthcare services. The 64% of people who put off treatment will grow even higher, so you can use this as an opportunity to lose market share. Or gain it.

HealthQRS is that third party and we have already created the patient-friendly interface. You can implement that solution today. We are a software-as-a-service (SaaS), so you have no capital investment, just a low monthly fee. We also have a smartphone application that consumers can use to access actual costs. Using our system instead of relying on the chargemaster will allow people to see actual costs and not suffer from sticker shock. You can use this to comply with the government’s requirements and also to market your services.

Our e-commerce medical marketplace platform is the perfect vertical application for integrated delivery networks. Our solution provides government regulation compliance and serves as a marketing tool for your services. At the same time, we will solve your bad debt issues caused by not collecting from consumers as well as many other benefits.

Just as providers jumped in with Apple to provide patient data for consumers to have easier access to health records, we suggest they do the same with HealthQRS to provide true price transparency and help the consumer where they need help the most: their wallets. Consider Maslow’s Hierarchy of Needs. If people don’t have food, clothing and shelter, they don’t care about self-actualization. Same goes with healthcare. When people are scared to seek basic healthcare services because they don’t know the cost – or they see the chargemaster and have sticker shock – they aren’t going to care about accessing health records on their iPhones.

Start with the basics: give people access to the real costs of healthcare. Give them a way to shop, schedule and pay for services from their phones. Once people return to utilizing healthcare services, then access to the patient record will make more sense. This is an opportunity to go beyond what the government is requiring. You can turn an edict into a positive for your market share. In addition, our solution will solve your bad debt issues because we help you collect upfront. Our solution can be used for large employers, payers, and even state governments to manage their Medicaid programs.

HealthQRS has over 15 years of experience developing healthcare retail experiences for people and our founders have over 50 combined years of e-commerce experience. Our E-Commerce Medical Marketplace Flyer provides more information. We invite you to contact us or schedule a demo right now to get a jumpstart on 2019.

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[1] Alex M. Azar II, “Remarks on Value-Based Transformation to the Federation of American Hospitals,” Mar. 5, 2018, https://www.hhs.gov/about/leadership/secretary/speeches/2018-speeches/remarks-on-value-based-transformation-to-the-federation-of-american-hospitals.html

[2] Jeff Byers, David Lim, Tony Abraham, “CMS pushes hospitals to post prices online,” Apr. 25, 2018, https://www.healthcaredive.com/news/cms-IPPS-2019-proposed-rule/522089/

[3] Ibid.

[4] Ibid.

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