Hospital Price Transparency
New Regulations, New Challenges, Vitalware HPI will help you meet them, quickly.
Following up on the hospital price transparency rule that went into effect in 2019, the Centers for Medicare & Medicaid Services (CMS) issued a series of proposed new rules in July, to take effect in 2020. These proposed rules significantly up the ante on pricing transparency, with a requirement for hospitals to post a publicly accessible and searchable list of at least 300 "shoppable services." The list must include 70 services selected by CMS, with 230 additional services, selected by the hospital.
Vitalware Hospital Price Index Is Ready When You Are
As a VitalCDM client, you’ll easily be able to identify the 70 services CMS has proposed for inclusion, and quickly facilitate the creation and sharing of your full list of 300 shoppable services with Vitalware HPI. You’ll also have the ability to display a "window of cost" for all of these procedures, displayed in a user-friendly interface that patients will be able to readily access and understand.
The Key: Price Benchmarking is Built-In
The most important thing to get right with transparency is assuring that the prices you calculate and display are competitive with your peer group.
With the benchmarking data Vitalware HPI provides, you don't have to worry about posting pricing that's too high or too low. Instead, the pricing insight we provide enables you to make strategic decisions around the mandate and to adjust or fine-tune your pricing wherever needed. Vitalware HPI allows you to review comprehensive CMS paid claim data statistics (via the Standard Analytical File), which gives your team average total charges for procedures and procedure-groupings based upon the most recent four quarters of data available from CMS.
With Vitalware HPI, the transparency demand can be fulfilled, and in the same effort, you'll improve your own competitive intelligence. Coupled with the ability to display low and high-end price ranges for shoppable items to reflect complexities and preferences, you have everything you need to be confident about how you calculate and display your pricing.
There are two primary components that make our solution work so smoothly: the HPI Admin Panel and the Patient View.
HPI Admin Panel
The Data and Tools You Need to Manage and Present Your Shoppable List.
Building Your Lists
The Vitalware HPI Admin Panel will quickly match the 70 shoppable item list selected by CMS with the items currently listed in the most recent copy of your chargemaster file. It also gives you the ability to query the chargemaster for additional items, using revenue and usage data to identify the additional 230 services appropriate for your facility to post in order to meet the required 300 price entries. The tool also offers the capability to add items that are not listed in the CDM file, such as DRG items and soft-coded items, to assure that a complete and accurate list is developed.
Making Your List Usable
Vitalware HPI provides a reference tool to review CPT/HCPCS codes that are "equivalent" (from a resource and clinical relevance standpoint), so that a simplified search list can be posted.
Vitalware has developed patient friendly descriptions, enabling patients to more easily parse the information they receive, and find the procedure(s) they're looking for in the posted list. Hospitals also have the option to create their own simplified descriptions if they prefer.
Hospitals are also able to control the timing for shoppable list(s) to be posted, and you can also control for any updates that may be needed. Vitalware will keep providers informed of any regulatory changes, but with Vitalware HPI, you won't be reliant on Vitalware personnel to finalize or publish the list.
As noted previously, Vitalware HPI allows you to develop and display a low price and a high price that accommodates for differences between complexities and preferences — enabling you to inform patients about variable costs. This capability is accessed and figures are finalized in the Admin Panel.
Providing Patient-Access to Your Shoppable Services List
Vitalware HPI offers simple Patient View hospitals can use to offer patients access to their shoppable services list. The display comprises two related sets of data, separated visually as tabs. The first tab contains the shoppable services list, and the second displays the related chargemaster file, arranged alphabetically, according to the patient-friendly descriptions approved by the hospital.
Searching The List
Patients have an easy-to-use and familiar search option, so they can quickly find the procedure they're looking for within the full list of shoppable procedures. To help make the list even easier to search, Vitalware HPI provides the means to parse the list by either inpatient procedure, outpatient procedure, or both. As mandated by CMS, the patient interface also displays all common billing codes, including CPT, HCPCS, and revenue codes.
Finally, Vitalware HPI displays the hospital calculated and approved ‘low’ and ‘high’ prices so that current and prospective customers can understand that any given procedure's cost may vary based upon various factors: including the health of the patient, supply cost, drug cost, physician preference, and procedure setting.
The Vitalware HPI Promise
- Vitalware HPI will enable you to create and display your shoppable services list as required by the new price transparency mandate.
- You'll have complete confidence that you're calculating and displaying competitive pricing information based on benchmarking data for your peer-group.
- Vitalware will assure that you're prepared to meet the practical demands of the shoppable list requirement by helping you quickly assemble, review, and present this information to patients in an easily searchable format.
Is Your Hospital Ready?
Vitalware HPI extends the significant advantages of having VitalCDM at the core of your mid-revenue cycle. With our solution, you will know the pricing you chose to display will be competitive, and you can face the new CMS regulations that emerge — in 2020, and beyond — with complete confidence.
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