The Mandate: Pricing Transparency expert Earl Winter to speak at Alabama HFMA Fall Institute

Join us at our Fall Institute on November 14th to learn more about Pricing Transparency as Earl Winter of Heath QRS presents a legislative update. Please see an excerpt from one of Winter's recent blog posts below.

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Fall Speaker

Price Transparency

President Trump issues price transparency executive order affecting both providers and payers…

It’s here folks. THE mandate. On Monday, June 24, 2019, President Trump signed an executive order requiring hospitals to publish negotiated rates with payers and both providers and payers to provide patients with out-of-pocket estimates in advance of procedures.

Both provider and payer groups have come out against the mandate, and there is speculation about just how much teeth any subsequent laws will have. However, consumer dissatisfaction with the status quo has made an impact on both Democrats and Republicans, so it’s safe to say that there will be legislation. If you are provider or a payer, get ready.

The news coverage is enormous. Search online for Trump price transparency mandate and you’ll have scads to read. The tip of the iceberg:

According to an article in Health Affairs, “the executive order directs an array of federal agencies to adopt rules, issues guidance, or develop reports with the goal of increasing the transparency of health care price and quality information.”[1]

Modern Healthcare reports: “Trump issued a general mandate for insurers and hospitals to disclose rates they have negotiated for “shoppable” services. These are common procedures and treatments that are widely available from hospitals and doctors. The intent of this rule is to give patients the chance to compare costs “before making informed choices based on price and quality.”[2]

HealthCareDive: “The executive order has two main directives:

● Within 60 days, HHS must propose a regulation “to require hospitals to publicly post standard charge information, including charges and information based on negotiated rates and for common or shoppable items and services, in an easy-to-understand, consumer-friendly, and machine-readable format using consensus-based data standards that will meaningfully inform patients’ decision making and allow patients to compare prices across hospitals.”

● Within 90 days, HHS and the Departments of Labor and Treasury must solicit comment on a proposal “to require healthcare providers, health insurance issuers, and self-insured group health plans to provide or facilitate access to information about expected out-of-pocket costs for items or services to patients before they receive care.”[3]

If you are at all concerned with keeping your market share, now is the time to act. Get a jump on your competition and do more than comply with a law that is sure to come.

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