More than two years have passed since Hospital Price Transparency Rule enacted. Unfortunately, America still suffers from high and highly opaque pricing across healthcare, hurting employers, workers, patients and taxpayers.The Centers for Medicare and Medicaid Services recently announced that in 2021 the $4.3 trillion This is almost double the average for other developed countries. Non-compliance and inflated prices still exist in a market where consumers are easily caught off guard, as costs become apparent only after care is provided.
According to a recent survey, only 16% of hospitals nationwide are compliant. Guidelines for price transparencyAt the same time, 100 million Americans have medical debt. Consumers have a hard time planning their healthcare costs because many hospitals do not clearly publish pricing information in a format that most people can understand.
Unfortunately, establishments are not encouraged to release this information, nor are large-scale accountability for violations. To date, only two of the thousands of hospitals in the United States have been fined for violations. This suggests little recourse to inaction.Not surprisingly, her two hospitals it was Penalized has made significant improvements. We have resolved transparency issues and adhered to pricing.
At the same time, a recent Kaiser Family Foundation poll revealed that 95% of Americans want policymakers to make healthcare spending more transparent a priority.
With policies in place and public support overwhelmingly high, why isn’t price transparency the norm?
Two years into the Federal Price Transparency Rule and into the third year of the COVID-19 pandemic, I predict five trends in the industry. These include industry adaptations, consumer behavior, payer practices, and an overall new focus on patient experience.
Trend #1: Industry navigates new rules and regulations
Hospital price transparency has been out of line with the expectations and priorities of the American public for years. Beginning January 1, 2023, payers must provide: online price estimator For Patients; Non-Compliant Faces stricter penalties than before. According to America’s Health Insurance Plans (AHIP), many private insurers (up to 94%) already offer such tools. But they must be comprehensive, covering all services and prescription drugs by 2024.
another recently enforced rules Hospitals must publish both in-network and out-of-network negotiated rates via a “machine-readable file.” This is another step towards the transparency consumers expect today, but these files tend to be complex and difficult to translate into actionable information. I have no doubt that hospitals and health systems will continue to struggle this year to make such data available to the public as much as the online tools I mentioned.
We expect 2023 to continue to include learning and adapting to what the “new normal” looks like. The healthcare landscape is uncertain and fluid, and it will be important for stakeholder organizations to be able to identify and respond to changes that are taking place. What needs to be considered is what information needs to be disclosed, what is the process for releasing such data, and how much data is readily available to consumers. Providers and payers will work to conceptualize and implement these new rules over the next few months.
Trend 2: Healthcare Shopping and Consumer Popularity Rising
Whether it’s buying a new TV, an airline ticket, or 12 eggs, consumers are in the habit of shopping at different locations and comparing prices. When price transparency opens up the healthcare market, more people will start buying healthcare services and procedures like any other product or service. 75% of consumers We consider healthcare decisions to be the most important and costly decisions they make. Unfortunately, predicting healthcare costs can be difficult, if not impossible.four fifths People find it difficult to compare costs. And because the average American consumer today doesn’t have access to an additional $500 in emergency costs, many procrastinate, not knowing what to expect. It could lead to more expensive medical accidents in the future, further driving up costs.
Price transparency means more patients can pursue and financially plan for the care they need. If patients were more committed to their care, we could see a workforce made up of healthier employees. cost savings for employersConsumerism in healthcare will continue to gain momentum as people become more confident in identifying prices and comparing costs.
Trend 3: Patient Experience Takes Industry Focus
Some of the patient’s experiences include: billing experiencePeople who know the cost of medical procedures in advance are more likely to avoid debt by planning accordingly, likely to pay Expedite their medical bills. In a healthcare market where consumers are more informed and exercise more agency overall, we expect the industry’s focus to shift to this aspect of the patient experience. Although the industry’s driving force, healthcare veterans and new entrants compete in the market for consumer loyalty.
Healthcare consumerism has a lot to do with cost and accessibility.However, it is net promoter score and overall patient satisfaction. Patients who take a more active role in purchasing care are likely to have stronger and more favorable opinions after services are delivered. We compete with leading providers to provide competitively priced care that exceeds patient expectations.
Trend 4: Employers want cost predictability
65% of US employees I have insurance through my employer’s self-financed plan. As a result of price transparency rules, more and more employers will consider partnering directly with providers to manage their healthcare costs. By partnering with healthcare providers, companies are expected to reduce healthcare costs for themselves and their employees. This direct relationship also gives companies greater visibility and predictability in managing the health care costs incurred by their employees. This is a difficult task, but one that is becoming increasingly necessary in the current situation.
Trend 5: Increased Benefits for Cash-Paying Patients
Finally, High Deductible Health Insurance (HDHP) subscribers: save out-of-pocket expenses By circumventing their insurance and paying a reduced upfront cash price for services.These discounted prices should now be published, so we expect consumers to take advantage of them more regularly. Number of Americans participating in HDHP is on the rise and there is a large gap that plans cover before they start covering, so many people are looking for alternatives to insurance claims when discounts are available.
These trends are nothing new in 2023. These trends have been gaining momentum in the market for some time now. Converging deadlines for transparency rules, tougher penalties for violations, and consumer behavior are certain to drive all five of these trends in the next 12 months. His one response from providers and insurers should include online price comparison tools that are consumer friendly and easy to use. Not only will this be a consumer expectation in the months and years to come, but these kinds of tools add value to the companies that actively provide them.
About Paul Ketchel
Paul Ketchel is MD Save Co., Ltd.Mr. Ketchel has over 10 years of combined experience in the healthcare industry. Mr. Ketchel is the founder of MDsave, Inc., the world’s first healthcare his marketplace. The value MDsave brings sets it apart from all other companies in the healthcare technology space. MDSave provides a bridge to transparency for healthcare systems without jeopardizing managed care contracts.
