The Hospital Transparency Rule: Lessons in Compliance and Patient Care

October 10, 2022

As of 2020, hospitals were required to publish prices in two separate places that were to be made readily available for consumers. This mandate was passed down via the 2020 Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule. The law was written for consumer protection purposes to address continually-rising healthcare costs across specialties.

The pricing requirements were as granular as possible. Inclusions included payer-specific negotiated charges, gross charges, and discounted cash prices, among others. Shoppable services were not excluded from the rule, which requested that hospitals show standard charges of these types of services for consumer use and reference. Beyond this requirement, healthcare organizations were also asked to have a digital file that offered consumers a complete and comprehensive view of the cost of every single service and item used in the patient care experience across specialties.

Organizations were given a short transition period to ready their systems and deploy their files for consumer reference. Despite this, implementation numbers were hitting record lows compared to previous mandates. According to the Journal of the American Medical Association, 6% of organizations were able to show full compliance with the law within the early months of the roll-out. As the design of this law is to protect the patients as much as possible from medical price gouging, champions of transparency remain vigilant and adamant that these laws must be implemented quickly — especially in the face of the ongoing COVID-19 pandemic.

Top-down leadership became an immediate need across healthcare groups, that decided to adopt a piecemeal implementation pattern or to forego the requirements completely (despite related fines and charges for non-compliance.) The matter was made more complicated by the dissent voiced from the American Hospital Association, which ended in a formal lawsuit against the HHS.

While the progress desired didn’t necessarily occur during the initial implementation period, lawmakers and healthcare workers alike remain committed to transparency and trust throughout the patient experience. Many acknowledge that price transparency and accountability is a key piece of this puzzle, and is required for a truly fair healthcare experience.

Hospitals and other healthcare organizations may choose to further digitalize their systems, using the mandate as an opportunity to enact top-down change for consumer benefit and the overall user experience. This could result in a more optimized experience for both caregivers and patients, opening up new opportunities for growth and revenue cycle changes.

As 2022 continues, Zotec will continue to be a leader and supportive partner for healthcare providers implementing and changes across organizations.