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The Big Story: CMS steps up enforcement and fines of hospitals in noncompliance with price transparency rule – Healthcare Finance News

“These enforcement updates will shorten the average time by which hospitals must come into compliance with the hospital price transparency requirements after a deficiency is identified.”

When is following a rule not about the rule?

By James Cervantes

2-minute read

Only a limited number of organizations – maybe as many as two-thirds – have complied with the CMS mandate that went into effect in January 2021.

Why have healthcare provider organizations, possibly yours included, slow-walked the move toward compliance? In short, it’s a complicated and expensive and technically demanding process that opens a can of worms – giving competitors and payers a direct look at your numbers – without really addressing the core goal of helping patients understand what their care might cost.

But that’s water under the bridge. Because now CMS has escalated enforcement of its previously confusing and inconsistent price transparency rule. And it’s time to comply. Or pay up – financially and reputationally.

Consider today’s landscape for provider organizations:

  • Financial fragility. Can any facility really afford to throw away a couple million dollars in fines? Now is not the time to skim corners or put a blanket over your head in the hope that CMS won’t find you.
  • Reputational fragility. We’re in a moment when provider organizations, particularly not-for-profits, are being attacked for myriad injustices both real and perceived. Avoiding price transparency, regardless of reason, hands hospital critics a gold-plated arrow for their quiver. You can hear it, right? “The CEO is making millions, yet they won’t tell patients what their care costs? What are hospitals dodging, what are they hiding?”

Now, flip those negative constructs and look not at the consequences avoided but at the gains to be had. Think about your mission. Done thoughtfully, price transparency that goes beyond the letter of the law will help build your reputation and fulfill your mission.

Want to increase your community’s trust in your organization? Being a proactive advocate for patients’ financial well-being along with their physical and mental health is a great place to start.

Want to get ahead of payers in your next negotiation and as a voice for financial clarity in the conversation about the business of healthcare? Show your numbers.

Whether it’s charity care, billing policies, patient access to their own PHI or, yes, price transparency, an organizational habit of openness will engender trust and head critics off at the pass. What’s not to like?

So, now is the time to at least meet the minimum requirement and hopefully work towards much more. Instead of wasting money on fines, invest in a thoughtful long-term strategy to guide patients through the financial component of their care journey.

As a marketing and communications leader, challenge your executive team to view this as an opportunity to reimagine the consumer experience. Suggest, “Let’s provide a constructive environment and process to help consumers make more educated decisions about their care – and how to pay for it.”

Point out that this is an opportunity to enhance your reputation, emphasizing your organization’s commitment to transparency and helping patients understand price and cost.

Practically speaking, here are some steps for Marcom leaders to advance this work.

  • Recirculate your price transparency plan. You likely had a micro communications plan to ensure internal and external communications were ready for the rule. Time to resurface your plan and approach.
  • Realign your leaders. Re-educate physicians and leaders to answer high-level questions and to direct employees and patients to your appropriate resources and information. Don’t know where they are?  Time to start looking and/or developing.
  • Connect with your board. Make sure your governing body knows where you stand on price transparency and what you’ve done (or haven’t done) to meet the rule requirement. Did you meet the bare minimum? Go above and beyond? Ignore completely? Importantly, why did you choose your particular route?
  • Scan your patient education and financial resources. You likely launched or relaunched these two years ago when the rule went into effect – check to make sure they’re up to date and accessible. Is it clear on your website or patient portal where this information lives?

Struggling to find, refresh or – worst case scenario – create for the first time your price transparency strategy and communications plan? Get in touch using the form below.