Last month, PatientRightsAdvocate.org (PRA) released its 4th Semi-Annual Hospital Price Transparency Compliance Report. While the report shows an increase in the percentage of compliant hospitals it reviewed (24.5% – up from 16% in its 3rd report), the criteria and conclusions are not consistent with those determined by the CMS in another recent report. In that report, released last month...
What is the Price of the Injuries in Die Hard?
Is Die Hard a Christmas movie? Well, it’s a movie that is watched most during the holidays, takes place during Christmas, and features Christmas as a plot point, so technically yes. But that’s the beside the point. We’re here to discuss what Die Hard would cost for John McClane and his local hospital because, let’s face it, he had a bad day.
Clever...
On Monday, CMS announced the availability of a standardized machine-readable file format that hospitals can elect to use in complying with the price transparency final rule. The sample formats, presented in .CSV and .JSON, are accompanied by a data dictionary. CMS notes that the use of these sample formats are voluntary. It’s also important to note that the samples contain fields that are no...
Listen to our President, Jamie Cleverley, join Riley Matthews, Lead Product Manager at Experian Health, to discuss the Hospital Price Transparency Rule and what it means for hospitals around the country. What challenges are providers seeing? How are facilities moving forward despite these issues? How is the disclosed machine readable file information being handled? What comes next?
Listen now! ...
How Do We Measure Hospital Costliness?
Because the majority of a hospital’s revenue is fixed by fee schedule or related to billed charges almost every hospital in the US is vitally concerned with their relative cost position. Quite naturally, hospital executives are interested in a facility wide metric of cost that can be benchmarked with their prior cost position and more importantly against o...
We Examine Myths of Healthcare Pricing
Hospital pricing is on the minds of many in the healthcare industry today, especially since the initiation of hospital transparency reporting. It is our belief, that many hospital pricing decisions often rely on widely believed pricing myths. The body of this article will attempt to define and confront some of these “myths.”
Myth # 1 Pricing makes a smal...
Why is Hospital Pricing Strategy So Important?
In many hospital executive’s minds, there is little need for strategy in the establishment of hospital chargemaster prices. This mentality can often create unfavorable outcomes that can affect the financial and strategic position of the hospital. Let’s review three common simplistic pricing strategies and the possible negative outcomes that might ...
Many healthcare providers have become very concerned about their posted charges for specific services and procedures in the new price transparency world in which they live. To this end, it is very common to see providers either reduce existing charges or refrain from price increases in selected areas. One very common result of price reductions is to increase the number of patient claims where a...
What is the relationship between hospital costs CMS quality rating?
At the time of this writing Medicare has provided incentive payments for improvements in hospital inpatient quality to approximately 3,000 acute care hospitals through its Value Based Purchasing (VBP) program. A number of commercial payers have also introduced VBP programs for payment to their participating hospitals. Th...
Cleverley + Associates Will Attend the HFMA Annual Conference
We’re headed to HFMA’s Annual Conference in Denver, Colorado. Bryan Gordon, our Senior Regional Account Executive will be presenting on Price Transparency, the history of regulation, what hospitals are facing now, and what might be next.
The HFMA’s Annual Conference is a three-day-long, interactive forum where attendees can learn abo...
How Do We Compare Payment Rates Across Health Plans and Hospitals?
Recently we were asked by a hospital client to address three common questions they hear from the public regarding price transparency. We’ve already answered “Why do Hospitals Offer Lower rates to Some Payers?” and “What Is The Relationship Between Insurance Contracts and What Members Pay?” so let’s look at “Why do Hospital...
What Is The Relationship Between Insurance Contracts and What Members Pay?
Recently we were asked by a hospital client to address three common questions they hear from the public regarding price transparency. Last time we answered “Why do Hospitals Offer Lower rates to Some Payers?” Now we’ll look at “What Is The Relationship Between Insurance Contracts and What Members Pay?” and next we’ll inv...
We Answer Questions About Hospital Payer Rates
Recently we were asked by a hospital client to address three common questions they hear from the public regarding price transparency. So, in our next three blog posts we’ll answer the following questions:
Why do Hospitals Offer Lower rates to Some Payers?
What Is The Relationship Between Insurance Contracts and What Members Pay?
Why Do Hospitals C...
A Response to the CY20 Opps Proposed Rule (CMS-1717-P) For Increased Price & Payment Disclosures
1) BACKGROUND
The CY20 OPPS Proposed Rule contains additional information and requirements regarding hospital price transparency. The proposal, which can be traced to guidelines provided in the Affordable Care Act, primarily follows several recent important government communications regarding th...
Die Hard Cost John McClane
Is Die Hard a Christmas movie? Obviously. Is it the greatest Christmas movie? Well, that’s up for debate. We’ll let your holiday dinner table take up that one.
But we at Cleverley + Associates can weigh in where we’re experts, which is hospital pricing data! Action movies, especially one as hard core as Die Hard, mean injuries and injuries mean hospitals. Sure, John M...
About Price Transparency
CMS did everything they proposed on transparency…including the very large increase in fines!
CMS has remained focused on the importance of Price Transparency, consistently stressing that their goal is to empower patients to make informed decisions regarding their health care. In their recent fact sheet, CMS called out what they called “sub-optimal compliance.”
We’ve cov...
Standard Machine-Readable File Recommendations for Hospitals
The CY22 proposed rule covered many topics, but, in our opinion, the guidelines and clarifications surrounding machine-readable files were some of the most critical.
The Proposed Rule’s observation that there was a “lack of uniformity in the way that hospitals display their standard charges (84 FR 65556)” wasn’t a great surp...
Are Hospitals Really Flouting Federal Requirements?
A new report by PatientRightsAdvocate.org claims that only 5% of US hospitals are fully compliant with disclosing their prices as required by the CMS. A summary of their report was featured in The Washington Post and has brought several questions from hospitals around the country. You can read The Washington Post article here.
The ...
CMS Price Transparency Requirements
As we continue our research into Price Transparency (you can see our full Spring Summit on the topic here), one of the things we wanted to know is are hospitals complying and, if so, how?
We conducted a survey of hospitals and took a close look at their approaches to the new Price Transparency requirements. Here’s what we found.
Our Methodolo...
CY22 Proposed Rule Change
As new Price Transparency regulations went into effect this year, most hospitals quickly adjusted to become compliant under the new rules. However, many were confused on some points, and some decided not to post their prices, choosing instead to see how CMS would approach enforcement and what, exactly, it regarded as compliance.
The new proposed CMS rule (CY 2022 Me...
Price Transparency Warnings
Since the passage of the ACA, Price Transparency has largely been a bipartisan issue, meaning that new rules and regulations have appeared, regardless of administration. CMS’ goal is to make it easier for patients to compare prices between hospitals. However, their final rule, which went into effect January 1st, had not yet been followed up by enforcement. CMS’ we...
How do Hospitals Compete with Free Standing Clinics?
The continued pressure on shoppable services has heightened the competition between hospitals and freestanding facilities. But what effect does this have on their day to day business? We analyzed the rate at which hospitals and their freestanding competitors have increased charges in four key groups from 2015 to 2019: imaging, procedures, ...
Last year the hospital industry faced major changes to the availability and accessibility of their prices. Now that 2021 is here, and the new CMS rules are officially in effect, CMS plans to audit how successfully the industry achieved compliance.
According to the CMS website they have already selected hospitals for their initial audits. We’re not sure how hospitals were selected for a...
Every year, as the winter holiday season rolls around, the greatest debate of our time resurfaces – is Die Hard a Christmas movie?
We at Cleverley + Associates believe that the answer to this question may be beside the point. What’s important are the traditions we create for ourselves, especially around the holidays. What really matters is what brings us together and make us feel happy...
How To Prepare for An Insurance Audit
Insurance audits can be an intimidating prospect, but they’re necessary and, unfortunately, inevitable. Even if an insurer didn’t single your facility out for an audit, you may be part of a random selection. Whether you’re preparing for a pre-payment review or a post-payment review, the general purpose of an audit, from the insurer’s perspective, i...
Another Way to Gauge Your Hospital’s Financial Health
Beckers recently published an article on how to gauge your hospital’s financial health, and they make excellent points. You can read the full article here. They cover many of the basics, including Aggregate Volume, Operating Ratios, Labor Costs Relative to Patient Volume, and Liquidity Ratios, but we believe there is another measurement t...
The FY21 IPPS Final Rule solidified a new requirement for hospitals to post the median payment (called the median “payer specific negotiated charge”) by MSDRG for Medicare Advantage (MA) plans. The plan is to use this information to establish weights for MSDRGs using hospital payments, as opposed to hospital costs via the current cost-to-charge ratio methodology. Per the rule, this transition...
About Hospital Pricing Transparency
On July 16, 2020 Cleverley + Associates presented a webinar on the final rule on hospital price transparency and the requirements for individual hospitals and systems.
Content included a description of the price transparency guidelines effective 1/1/21, a list of important action items hospitals must implement, and a discussion of the two different ...
Why We Need To Rethink Adjusted Discharges
Healthcare and hospital finance have changed dramatically over the last few years, and yet there are many things that seem slow to change. One of these is the continued reliance on Adjusted Discharges or Adjusted Patient Days.
Adjusted Patient Days made perfect sense at one time. The percentage of outpatient revenue was less than 20 percent o...
Cleverley + Associates Introduces the Consumer Shoppable Report!
Shoppable services, and the issues of pricing transparency indelibly connected to them, are a hot topic in the hospital industry. In the past we’ve created several reports to help hospitals who are searching for strategies to reduce prices, by focusing on procedures where they are likely to have the most competition from free-s...