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Getting Ahead of Price Transparency: Strategies to Help Patients Better Understand Costs

Patient demand for access to reliable pricing information in advance of care is growing. Recognizing this trend, CMS proposed a new rule around price transparency outlining requirements to further provide information on costs of care online. The final rule will take effect on Jan. 1, 2021.

The rule will require hospitals to post “consumer-friendly” pricing information online, helping mitigate confusion around the charge master pricing information currently required. This “friendlier” pricing would include payer-specific negotiated rates by specific plan for common services.

Patients — who are increasingly seen as payers just as much as insurance companies in today’s market — expect and want to know costs. Bottom line, healthcare consumerism is here to stay, so it’s important providers take note.

Below are a few ways your organization can better meet consumers’ expectations — and improve the patient experience, financially and holistically. 

  • Post price ranges of common procedures
    While prices differ — depending on payer coverage and provider contracts — the data exists to identify a price range for frequent procedures. For example, the cost of an MRI of the knee can range between $425 to $2,800.1 Prices also fluctuate based on whether a patient is insured or self-pay — which can further vary prices depending on prompt pay, needs-based discounting or insurance plan coverage.
  • Calculate median prices of treatments
    Review your datasets for common treatments and post median prices to give patients a general idea of cost expectations. This also removes the need to calculate costs based on outliers, such as treatments that had complications or comorbidities. It’s also a good way to give ballpark estimates for procedures with a wide range of interventions.
  • Continue to relay cost information when the price tag is finite
    When pricing information is clear, report it out. Some procedures have a high level of predictability — such as diagnostic testing — where you can confidently estimate to the penny. This strategy won’t work in other areas, such as surgical procedures, the emergency department or inpatient care, since there’s so much variance in interventions.

Most consumers are accustomed to receiving estimates, whether it be for contracted work on their home, car repairs or another service. The expectation in healthcare is no different. The industry needs to remove the opacity from pricing by properly equipping consumers with the right tools. Innovative organizations are positioning a transparent revenue cycle to meet the patient as a payer.

Learn more about price transparency facts in our infographic and explore results from our recent patient survey.

Used with permission: Copyright Healthcare Business Insights, 2019.


The materials available on this page are for informational purposes only and not for the purpose of providing legal advice. You should contact your attorney to obtain advice with respect to any particular issue or problem.


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