The New Price Transparency Rule: What it Means for the Patient Experience in 2021

A new CMS rule is changing the patient experience. What can healthcare organizations do to navigate this change and work toward improving the overall patient experience? Read on to hear best practices and learn what's coming next for patients.

It’s a story we hear too often. A person visits a hospital for a medical issue, whether it be a trip to the emergency room for a broken arm or a pre-scheduled appointment for a headache that just won’t go away, and receives a myriad of services and tests. Then comes the dreaded bill in the mail a few weeks later. Although they may inquire about an estimate at the time of service or have an idea of their coverage, the exact financial responsibility is often a mystery until that bill arrives. And while the changes vary greatly, one thing that is certain: many people have trouble with their out-of-pocket costs, so much so that a recent survey from The Commonwealth Fund found that 72 million Americans have some sort of trouble with medical debt.

On January 1, 2021, a new rule from the Centers for Medicare and Medicaid Services (CMS) was put into effect requiring all hospitals within the United States hospitals to publish the prices of various medical procedures. In particular, standard charges for services and items must be published online, available for patients to access.  Until now, these prices were hard to find.  The timing of this change – the beginning of the calendar year – comes at a time when healthcare pricing is top of mind. Customers most likely renewed or changed insurance carriers and coverage for January 1, 2021. With this comes a focus on out of pocket costs, deductibles and more.

So what brought about this radical change? Part of it can be attributed to the consumers themselves. With the increase in high deductible health plans and increased out of pocket costs, finances are top of mind. In addition to these factors, today’s consumers demand a better overall patient experience. With the prevalence of online shopping, patients expect the same seamless transaction at the hospital that they receive with companies like Amazon. And just as consumers read product reviews before placing an item in their online shopping cart, patients research services and access peer reviews of physicians. In short, they want to be knowledgeable about their healthcare, and crave tailored services with exceptional customer service.

Many believe this change will be well received, with Forbes calling the ruling a “gift to all Americans.” From the consumer’s standpoint, it will now be easier to make educated decisions based on cost. This will cut down on the “unknown” – hopefully eliminating those hefty surprise bills – and opens the door to comparison shopping. Advocates are hoping this newfound transparency will eventually lower costs, with the competition eventually driving down prices.

How can healthcare organizations navigate this change and work toward improving the overall patient experience? Not only by promoting transparency, but also with convenience. By enabling patients to access and pay their bills on their own schedule with easy-to-implement solutions, organizations are meeting them halfway, so to speak. With easy-to-understand statements, integrated credit card processing and 24/7 payment portals, it’s no longer a hassle to manage medical financials. For healthcare organizations, facilitating proactive management of a person’s cost of care accelerates revenue collections and patient satisfaction improves.

In the larger sense, executives recognize that patients are taking more stock in their personal care. In order to thrive, hospitals and health systems must work toward creating the optimal patient experience, beyond just price transparency. With this, providers should aim to be more engaged and C-suite executives should try to provide additional benefits to their patients. What will this new rule and focus on healthcare consumerism mean for the future of the industry? Only time will tell. However, it is safe to say that this concept has the possibility to shape healthcare policies and processes for years to come.