The WHA Transparency Task Force (TTF) convened for its final meeting Dec. 5 to discuss its forthcoming report on price transparency best practices and recommendations for policymakers.
WHA Director of Federal & State Relations Jon Hoelter provided an update on transparency initiatives from Congress and the Trump administration. Hoelter gave a summary of the final
transparency rule requiring hospitals to post a “machine readable” file containing all privately-negotiated health insurance contract rates. While the final rule gives hospitals an extra year for implementation, going into effect Jan. 1, 2021, it also will require hospitals to post the deidentified minimum and maximum rates they negotiate, as well as cash-discounted rates.
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lawsuit was recently filed by hospital groups, led by the American Hospital Association, challenging the Trump administration’s authority to require the disclosure of proprietary rates, making the final implementation of the rule uncertain. On the Congressional side, lawmakers may try to attach provisions to end surprise medical billing to a spending package that must pass by Dec. 20 in order to avoid a government shutdown. WHA will continue to engage with lawmakers to stress the importance of avoiding a mechanism that mandates government-set rates to end surprise billing.
WHA Senior VP of Finance and Chief Operating Officer Brian Potter and WHA Information Center (WHAIC) VP Jennifer Mueller presented the final version of the new “Charge Analyzer” tool to the TTF. Beginning Jan. 1, 2019, the federal government required hospitals to post its “standard charges” on the hospital’s website in a machine-readable format. Given the broad scope of services provided by hospitals, a chargemaster contains thousands of services and charges. WHA and the WHAIC wanted to develop a user-friendly tool that would allow hospitals a systematic way to analyze these charges.
Powered by Tableau, the WHA Charge Analyzer guides the staff user by “drilling down” from service line selection to individual charge analysis. Line item charges can be compared to a self-selected peer or peer group. There are additional data in the tool that help put the charges into context, including information on volumes, average age of the patient, payor mix and percent variance from peer or peer group. Another option within the tool is to create an Excel file extract of charges at the code level for those that are more comfortable with a data download. Using the WHA Charge Analyzer, member hospitals can have a better understanding of how their charges compare to peers and where outliers, both high and low, exist. This will help hospitals target areas for further charge analysis and will help hospitals better explain their charges should they receive a patient or media inquiry. The WHA Charge Analyzer can be used for both inpatient and outpatient related charges.
The TTF also reviewed the WHA Transparency Task Force Report, which documents the leading-edge initiatives underway in Wisconsin, and provides recommendations for policymakers as they consider proposals related to surprise billing and price transparency.
The report highlights WHA member support for efforts to improve the patient experience through transparency, and the fact that WHA and its members are leading the way to provide patient-friendly tools and information, and intervene to resolve issues when necessary. The WHA TTF report recommends the following priorities as policymakers debate these issues:
- Put patients first, and focus on solutions that provide useful information to patients
- Work with all stakeholders to achieve consensus-driven solutions
- Reject provisions to establish government-set benchmark rates
- Leverage and encourage the ongoing movement toward transparency with incentives
- Respect the innovation of industry leaders and reject one-size-fits-all mandates
- Reject new mandates that would be burdensome, likely lack legal authority, and could even be counterproductive to the goals it sets out to achieve
- Consider which stakeholder groups are best positioned with access to information when developing requirements
The report was shared with the WHA Board at its Dec. 12 meeting, and will be submitted for formal approval by the Board in 2020.
For more information on this topic, contact WHA Director of Federal & State Relations
Jon Hoelter.