Media Recap: Price Transparency & Staffing Crisis

The MHA responded to several media requests the week of Oct. 25 that focused on hospital price transparency and the on-going staffing crisis.

The Detroit News published Oct. 24 a story on the staffing shortage impacting EMS workers and touched on the staffing crisis impacting hospitals. MHA CEO Brian Peters is quoted in the story discussing the lack of availability of transport for patients to lower levels of care, resulting in increased cost and strain to the healthcare system.

“They are in crisis mode,” said Peters. “These are not only front-line clinical staff who are in short supply, but also non-clinical staff. … We are struggling on both counts.”

The MHA also provided statements to stories published by Crain’s Detroit Business and WXYZ Detroit on the federal price transparency rule.

“In addition, there is ambiguity within the final rule that has left hospitals to interpret the level and detail of pricing information that should be provided to consumers,” said the statement published by Crain’s. “Hospitals and health systems are working diligently to comply with federal policies in their release of information.”

Members with questions on COVID-19 efforts and resources should contact Ruthanne Sudderth, and any questions regarding media requests should be directed to John Karasinski at the MHA.

Implementation Delayed on Portions of No Surprises Act

The federal departments of Health and Human Services (HHS), Labor and Treasury recently issued a frequently asked questions (FAQs) document regarding requirements for providers and health plans under the No Surprises Act and the Transparency in Coverage final rule.

Under the No Surprises Act, providers and facilities are required to prepare a “good faith estimate” of expected charges for the services the patient has scheduled. This includes expected charges for other providers and facilities used in the services. The notice is provided to the health plan or other source of coverage and will be required beginning Jan. 1, 2022.

The FAQ document says the HHS will not complete the necessary rulemaking to implement this provision of the No Surprises Act by Jan. 1 and will delay enforcement. However, the HHS does intend to do rulemaking to implement the requirement to provide an estimate of charges to patients who are not enrolled in health coverage or who will not be making a claim for services (i.e., paying out of pocket.)

The delay in enforcing the good faith estimate will also delay enforcement of the requirement that health plans and other sources of health benefits provide an “Advanced Explanation of Benefits” after they receive the estimate from the provider. The FAQs do not indicate when rulemaking will take place or estimate when enforcement will begin. For more information about these requirements and enforcement delays, contact Laura Appel at the MHA.

Webinars Outline Transparent Marketplace Strategies

Most hospitals and health systems are complying with the Centers for Medicare & Medicaid Services Hospital Price Transparency Final Rule that took effect Jan. 1. The next step is to identify ways to manage patients’ concerns and expectations about what they will likely pay and how to demonstrate the organization’s quality and reputation as the foundation for pricing.

Two upcoming webinars focus on price transparency strategies. The webinar Tracking the Push for Price Transparency in Healthcare will take place from 2 to 3:15 p.m. March 2, led by the corporate director of program development with the National Research Corporation, the largest surveyor of healthcare consumers in the U.S. The session will outline the future power of price transparency as a potential relationship builder for consumers and patients. The webinar Pricing Strategies in a Transparent Marketplace will be offered from 11 a.m. to noon March 10. An expert in operational improvement of billing and reimbursement will review the pros and cons of pricing strategies and how to use price transparency as a market opportunity.

Registration for both webinars is free of charge thanks to PARA Healthcare Analytics, an MHA endorsed business partner providing a value-based solution for the revenue cycle process. A short video about PARA Healthcare Analytics explains its pricing, coding, reimbursement and compliance services. Members with questions should contact Erica Leyko at the MHA.
 

Webinars Will Examine Price Transparency Strategies

The Centers for Medicare & Medicaid Services Hospital Price Transparency Final Rule requires hospitals to post online standard charges for 300 “shoppable” services effective Jan. 1. Hospitals and health systems need to highlight their best attributes, because the way patients shop for healthcare are expected to be similar to how they shop for other items, where differences in reliability and safety could prompt them to consider the more expensive option.

The webinar Tracking the Push for Price Transparency in Healthcare will be offered from 2 to 3:15 p.m. March 2. This webinar will outline how to redefine the consumer journey through pricing and payment, emerging ideas and practices to seize price transparency as a market opportunity, and the future power of price transparency as a potential relationship builder for consumers and patients.

The webinar Pricing Strategies in a Transparent Marketplace will take place from 11 a.m. to noon March 10. It will help participants gain a broader understanding of their organization’s competitiveness with geographical peers and freestanding markets, review the pros and cons of various pricing strategies, and analyze payer contracts to better understand restrictions.

Registration for both webinars is free of charge thanks to PARA HealthCare Analytics, an MHA endorsed business partner providing a value-based solution for the revenue cycle process. A short video about PARA Healthcare Analytics explains their pricing, coding, reimbursement and compliance services. Members with questions should contact Erica Leyko at the MHA.

Laura Appel Discusses New Federal Price Disclosure Rule

Laura Appel WWMT

MHA Senior Vice President Laura Appel appears on WWMT-TV News Channel 3 on Jan.6Laura Appel, senior vice president and chief innovation officer, discussed the new federal hospital price disclosure rule with the Detroit Free Press and WWMT-TV the week of Jan. 4.

The Detroit Free Press story published Jan. 6 quotes Appel discussing how caring for a surge of COVID-19 patients may impact the rate at which hospitals are able to comply with the federal rule.

“It’s still a pandemic and most organizations are still in what we’d call a surge mode," said Appel. “It’s still a pretty tenuous time, so it wouldn’t surprise me if some (hospitals) said, 'We’re working on it, but we’re not there yet.' "

On Jan. 6, Appel contributed to a WWMT-TV story explaining what is now required of hospitals with the new rule.

"What's now required to be published are each negotiated rate for a particular type of service," said Appel.

Resources Available for Complying with CMS Hospital Price Transparency Final Rule

The MHA hosted a webinar Nov. 10 to assist members in complying with the Centers for Medicare & Medicaid Services (CMS) hospital price transparency final rule that takes effect Jan. 1. Hospitals will be required to post online, in a machine-readable format, their standard charges for all items and services provided and payer-specific negotiated rates for 300 “shoppable” services.

A recording of the webinar is available online for those who were unable to participate. Members with questions should contact Erin Steward at the MHA.

Another opportunity for hospital finance leaders to learn about the transparency regulations and resources available for purchase to assist with compliance is available Nov. 18, when representatives from PARA HealthCare Analytics will present an interactive webinar to explore solutions and strategies for compliance with the price transparency rule. PARA is a new MHA endorsed business partner that specializes in the healthcare revenue cycle. For more information on the Nov. 18 webinar, contact Rob Wood at the MHA.

Prepare to Post Hospital Charges, Rates by Jan. 1

The MHA will host a webinar from 1 to 2:15 p.m. EST Nov. 10 to discuss the Centers for Medicare & Medicaid Services (CMS) Hospital Price Transparency Final Rule.  Beginning Jan. 1, hospitals will be required to post online, in a machine-readable format, their standard charges for all items and services provided and payer-specific negotiated rates for 300 “shoppable” services.

Finance leaders have assumed the court was going to strike down the rule or advocates would succeed in delaying it, but the CMS has been clear that it is considering other reporting requirements tied to Medicare reimbursements to encourage hospitals to provide the requested information. Now is the time to plan for and identify the potential compliance concerns with price transparency.

Leading the webinar is Kathy Reep, senior manager with PYA, a healthcare financial consulting firm with more than 300 professionals across offices in the Midwest and South. Reep has more than three decades of experience in Medicare and Medicaid compliance, finance and reimbursement, and managed care.

For more information on the webinar, contact Erin Steward at the MHA.

Lawsuit Dismissed, Allowing CMS to Require Payer-specific Payment Rates

A federal judge in Washington, DC, recently dismissed the lawsuit challenging the Centers for Medicare & Medicaid Services’ (CMS) Price Transparency Final Rule that requires hospitals to disclose their privately negotiated, payer-specific payment rates effective Jan. 1, 2021. Plaintiffs in the lawsuit include the American Hospital Association (AHA), three other national organizations representing hospitals and health systems, and three hospitals in Nebraska, Missouri and California. Released Nov. 15, 2019, the transparency final rule requires hospitals to make their “standard charges” public in a machine-readable file and in a consumer-friendly display for 300 shoppable services. Key issues of the lawsuit are:

  • A provision that mandates public disclosure of individually negotiated rates between hospitals and commercial insurers. The lawsuit asked the court for relief on the basis that the U.S. Department of Health and Human Services lacks statutory authority to require and enforce this provision.
  • An argument that the provision violates the First Amendment by compelling the public disclosure of individual rates negotiated between hospitals and insurers in a manner that will confuse patients and burden hospitals.

The CMS presented additional pricing transparency requirements as part of the proposed rule to update the Medicare inpatient prospective payment system for fiscal year (FY) 2021. If finalized, the FY 2021 rule would mandate that hospitals report the median payer-specific negotiated rates for inpatient services by Medicare-severity diagnosis-related group for Medicare Advantage plans and third-party payers on the Medicare cost report for cost reporting periods ending Jan. 1, 2021, and after. The MHA will oppose these requirements in its comments to the CMS and encourages hospitals to do likewise in their comments due to the CMS July 10.  

Michigan hospitals remain committed to increased transparency around healthcare quality and costs, including price information for patients. Hospitals voluntarily share quality data on VerifyMiCare.org. The AHA and other plaintiffs are expected to appeal the recent court decision on an expedited basis. The MHA will continue its efforts to assist hospitals in ensuring they are compliant with the transparency final rule prior to the Jan. 1, 2021, effective date. Members with questions should contact Vickie Kunz at the MHA.

MHA Service Corporation Board Addresses MHA Action Plan Priorities

MHA Service Corporation

The MHA Service Corporation (MHASC) convened a meeting of its board Jan. 30 to assess and further develop programs and services to support key initiatives in the 2019-2020 MHA Action Plan. 

MHA Service Corporation The board received a report on activities of the MHA Enhanced Data Task Force, which was established to identify data priorities, pilot initiatives, governance and privacy issues, and value propositions, providing guidance and recommendations to the MHA Board of Trustees. The MHASC Board continued to discuss how best to position the association and its members to collect and use data to drive improvements in population health, advance advocacy objectives, and serve members’ operational needs. The MHASC Board also received an update on the Centers for Medicare & Medicaid Services rules for price transparency and discussed their impact at the federal and state levels.

In addition, the MHASC held the inaugural meeting of its Human Resources Committee to address current issues, consider future healthcare workforce needs, and provide input to the MHASC Board on innovative solutions to improve value and performance. Workplace safety and wellbeing is an MHA strategic priority and is supported by education and training from MHA Endorsed Business Partner HSS and efforts of the MHA Workplace Safety Collaborative. The committee provided feedback on activities in these areas and reviewed the initial charter. Its next meeting will be held in conjunction with the Michigan Healthcare Human Resources Conference in March.

The MHASC board welcomed its newly appointed members as approved by the MHA Board of Trustees at its last meeting, including Betty Chu, MD, MBA, associate chief clinical officer and chief quality officer, Henry Ford Health System, Detroit; Brian Connolly, retired CEO and chief transformation executive, Beaumont Health System, Southfield; Marita Hattem-Schiffman, president, MidMichigan Medical Center-Gratiot/Mt. Pleasant/Clare; and Kent Riddle, CEO, Mary Free Bed Hospital, Grand Rapids.

To learn about MHASC services available to MHA members, visit the MHA Business Services webpage. Questions on these options or about the MHASC board and human resources committee meetings should be directed to Peter Schonfeld at the MHA.