正如我们之前提到的 帖子, CMS has implemented additional hospital price transparency requirements for 2024. 有了这些新要求, CMS is demonstrating its seriousness about price transparency by calling for disclosure of additional information, 标准化数据格式,方便第三方进行聚合, 加强监管和执法力度.
对于已经在努力应对资源限制的医院, 这些新要求可能会成为不受欢迎的负担, and it would be tempting to do the very least amount of work possible to comply with them. 然而, hospitals would do well to embrace these requirements and take advantage of the information that price transparency makes available.
新规则概述
2024年冬奥规则有很多变化, 哪些主要属于机器可读, comprehensive file of all standard prices (as opposed to the separate list of 300 “shoppable services”). 更改包括以下内容:
- 报告功能可促进跨医院的数据聚合
CMS clearly intends to facilitate the aggregation of hospital data by third parties who will package that information for release to the public. 1月1日生效, hospitals are now required to include content on their websites that helps users navigate to the comprehensive machine-readable files. 七月开始, those files will also have to include information identifying the hospital whose data they contain, presumably so that data aggregators do not have to provide this data themselves. 另外, CMS在这些数据文件的格式上已经变得更加规范, again with the apparent intent of creating standardization that will facilitate aggregation.
- 付款方法说明
七月开始, hospitals will need to express this information as a percentage of charges or other algorithm as applicable, 以及为这些bet8娱乐支付的历史金额. In effect, this allows third parties to reconstruct a payer’s payment methodology.
- 医院主管的证词
A hospital’s designated representative will need to provide an attestation that all the information contained in the machine-readable file is complete and accurate to the best of their knowledge. CMS believes this will better enable them to enforce accountability and resolve any outstanding questions regarding the data being submitted.
- 增加执行
CMS now reserves the right to conduct comprehensive compliance reviews of a hospital’s standard charge information and to publish the results of that review, along with any compliance actions taken against the hospital and any notifications sent to health system leadership. 这些步骤是CMS当前执行的审计之外的附加步骤, which have increased significantly in number since the program was first implemented.
医院应该怎么做
Given that price transparency requirements have only gotten more rigorous since they were introduced three years ago, it seems unlikely that they will be relaxed within the foreseeable future. 像这样, hospitals should think seriously about how to take advantage of the information being made available to the public. 我们在下面提供一些建议.
- 确保你的医院是合规的.
First and foremost, don’t get caught in CMS’s crosshairs for failing to meet these requirements. 该行业在接受价格透明方面总体上进展缓慢, which likely explains why CMS is enhancing its monitoring and imposing stiffer penalties for those that don’t take the necessary corrective actions. 另外, 通过在其网站上张贴违规信函, CMS将医院高管暴露在公众的监督和羞辱之下.
- 准备好花时间审查合同语言.
Because CMS is mandating that machine-readable files include the methodology for calculating payment, hospitals will need to compile this information and include it in their comprehensive price files. In some cases, hospitals may have to create links to external descriptions of a payer’s methodology. 履行这一职能需要付款人合同方面的专门知识, which may be outside the scope of the in-house staff and external vendors who have previously been responsible for publishing a hospital’s price transparency information.
- 利用价格透明度作为评估你的付费策略的机会.
医院被要求每年更新他们的价格信息, 这提供了一个评估他们的付款策略的机会. 通过执行刷新, hospitals must compile their own pricing information at a detailed level; having accomplished this, they can then readily compare their information to that of competitors and peers using an ever-expanding number of market data sources.
Conducting this review will assist hospitals in thinking about how they price their services strategically. It may no longer make sense to seek across-the-board rate increases; instead, hospitals will need to determine which services are commodities to be priced competitively and which ones are differentiated, 这样医院就能得到高价.
- 在付款人谈判中利用市场数据.
The availability of market pricing data can have a dramatic impact on a hospital’s ability to negotiate rates with payers. We are already using this data to great effect when we assist clients in payer contracting, as it removes much of the information disparity that payers have historically used to their advantage. 随着数据变得更加健壮,其可靠性提高, it will prove to be an indispensable component of a hospital’s negotiation strategy.
It's interesting to note that our price transparency regulations are the product of work performed under the current and prior presidential administrations. 这个概念具有广泛的吸引力,因为几十年来, patients have been largely in the dark when trying to understand the cost of their healthcare. 类似的, hospitals and other providers have traditionally had little visibility of how their prices stack up against those of their peers. 这种情况正在迅速改变, and providers who are thoughtful about how they respond to this increased visibility will be best positioned for success.
你的组织准备好提高能见度了吗?
编辑:马特·马斯林
出版于2024年2月8日