May 22, 2019
Why the Best Weapon in Washington is Your Story
In this era of increased transparency, it’s more important than ever for healthcare leaders to explain their work to CMS.
The Trump administration has ramped up pressure on hospitals to become more transparent.
At the beginning of 2019, the Centers for Medicare & Medicaid services required providers to publish their chargemasters. Early this year, CMS issued rules that would penalize hospitals that block patient access to personal health information and interoperability of data, as well as more price transparency requirements.
The pressure will only get more intense, according to Keith Snider, policy director at the Washington D.C.-based consulting firm Health Policy Source.
To improve the signal-to-noise ratio in conversations about healthcare policy, we recently spoke with Snider about the changes coming out of Washington that really matter and why it’s more important than ever for healthcare leaders to tell their story.
There’s been a flurry of activity from CMS lately. In your opinion, what’s the most impactful rule that the agency has passed?
I’d say the hospital chargemaster rule is a big one. By doing that, the administration is demanding hospitals release a lot of information from what is historically the biggest cost center in healthcare: hospital care. Ultimately, that will be a gamechanger.
Were you surprised that CMS made this demand of hospitals?
I think we saw this coming. Even in the Affordable Care Act, there was a requirement that hospitals list the price of some common and expensive surgical procedures. But what may be unusual this time is how firmly the administration has stuck with the requirements. In the past, in cases where there’s been a lot of pushback, the agency has been willing to modify or phase in new policies over a number of years.
But now CMS is taking a stance more along the lines of, “We know it’s not easy. We hear you, but we’re going to require you to do it anyway.” They’re making healthcare providers press forward through the caveats and complications. That’s something new.
Is it fair to say that lawmakers have been focusing more on transparency, even before this administration?
Yes. After the last election, we said that for the price transparency issue in healthcare, it really wouldn’t matter whether Donald Trump or another Republican were in office. It wouldn’t even matter if it was a Republican or Democratic administration for that and related issues. In other areas, there would be huge difference. But in this area, there’s an ongoing move towards value-based payment and a focus on consumer costs. This was happening during the Obama administration. Those trends were in existence before and they’re going to continue regardless. There’s a lot of bipartisan support. We’ve been telling clients that for some time.
Many of these rules are tough on hospitals. Do you think patients will ultimately benefit?
The initial take is that most will be somewhat useful, but not as useful to the average patient as it is going to be to organizations such as Health Affairs or Kaiser who are doing deep analysis of pricing trends and patterns.
But there are signs people are making some sense of it. Some hospitals are listing bundled payments, for example. And high-deductible plans are forcing people to figure out the cost side of the system. In general, people want to have more information about what their care is going to cost.
What are you telling clients to actually do about price transparency policy?
Well, obviously if something is required by federal regulation, clients have to do it. We aren’t in a position to tell people not to pay attention to that, though they obviously have a range of concerns.
That’s fair. If they have to comply, what would you say to healthcare leaders looking to stay ahead of coming policies?
First off, you have a good story to tell. If you’re providing quality patient-centered care, you have to tell that story – even, sometimes, use it to explain to the agency why they’re doing something that’s not advisable. Help them find a way to do something better or differently.
In this case, it’s important for providers to tell not just how they’re meeting the letter of the policy but what they’re doing to advance the spirit of the policy. Several of our clients are going beyond federal requirements for disclosure, patient outreach and care transitions. Many are doing that even though it doesn’t result in higher reimbursement, but because they’re convinced it’s going to drive better care. They need to talk about that. Beyond that, they have other ideas on ways healthcare can be smarter and more efficient – what we mean when we talk about “spirit” vs. “letter.”
If you have smart ideas, bring them to Washington, but along with that, bring your story. Tell the agencies what you do and why you do it – why it’s important to consider your suggestions. Then, if they’re willing to listen, work with them to get those policies implemented.