Revenue Solutions: Pricing Transparency Preparedness
Pricing transparency has long been a goal of healthcare regulators. The recent push by consumers and patient advocacy groups is escalating this movement. Organizations lacking a defensible pricing structure are at increased risk for running afoul of regulators and patient advocates as evidenced by CMS 2019 proposed IPPS changes.
Price transparency in healthcare is more important now than ever before. This year CMS has expanded this initiative through their recent proposal in the 2019 Inpatient Prospective Payment System. The proposed rule would require hospitals to publish a list of their standard charges online and to make this information publicly available or available upon request. Are you comfortable publishing your charges without a pricing transparency preparedness assessment?
FTI Consulting Approach
FTI Consulting teams approach the challenge of optimizing our clients’ pricing structure by ensuring that all pricing is consistent, defensible, market sensitive and able to be reproduced as new services, supplies and pharmaceuticals are added to their Charge Description Masters (CDM).
At FTI Consulting, we continuously stay abreast of pending regulations to assure our clients are well prepared. We take pride in our ability to tailor a pricing approach which is consistent with the business needs of the organization. In some cases, this includes helping to identify the business needs through external market comparisons to determine how pricing stacks up against our client’s local market.
Many organizations have experienced inflation of pricing over the years for many reasons. “Across the board” price increases were once common practice, and in some cases still occur within organizations. Additionally, the prevalence of percent of charge contracts has incentivized some organizations to increase pricing to enhance reimbursement. These tactics can lead to unintended price increases for items such as common drugs and supplies, resulting in potentially uncomfortable conversations when asking a patient to pay his or her contractually obligated portion of the bill.