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SunStone Consulting, LLC(TM): New Executive Order Increases Pressure on Hospitals to have Rational/Transparent Pricing

HARRISBURG, Pa., July 2, 2019 /PRNewswire/ -- President Donald Trump issued an "executive order on improving price and quality transparency in American healthcare to put patients first" on June 24th in an effort to pressure the healthcare industry, including insurers doctors and hospitals, to disclose more information about their prices. The Department of Health and Human Services ("HHS"), through this executive order, will be responsible for directing and regulating how healthcare providers and insurers disclose negotiated payment rates for services and provide patients with estimated out-of-pocket costs prior to receiving care.

A vital element is that the executive order does not specify how these goals will be accomplished, rather directs HHS to issue a series of rules that relate directly to price transparency for hospitals, doctors and other healthcare providers.  Or, as the executive order states, "Informing Patients About Actual Prices" by enacting the following:

  • Hospitals will publicly post standard charge information, including charges and information based on negotiated rates and for common or shoppable items and services, in an easy-to-understand, consumer-friendly, and machine-readable format using consensus-based data standards that will meaningfully inform patients' decision making and allow patients to compare prices across hospitals.
  • Healthcare providers, health insurance issuers, and self-insured group health plans will provide, or facilitate access to information about expected out-of-pocket costs for items or services to patients before they receive care.

Along with virtually the entire healthcare industry, SunStone Consulting ("SunStone") supports efforts to accomplish the purposes stated in the executive order, including providing patients with the necessary pricing and quality information to make informed decisions regarding their healthcare. We believe that the cost of healthcare, including the out-of-pocket costs incurred by patients is an issue that requires addressing, however, how the country arrived at the current undesirable state is complex and requires the participation of the federal and state governments, insurers, healthcare providers and patients.

While the problem and the solutions are both complex, SunStone believes all healthcare providers should ensure that their patient pricing policies are carefully developed and are consistent with the organization's mission and governance. And, importantly, how their individual patient prices are set should be thoughtful and fully documented.

SunStone has been fully immersed in the subject of patient pricing for over 30 years and  has been integrally involved in helping providers with rational and defensible pricing, including being published in industry guidance like HFM. Increasingly, providers are finding themselves in a defensive position trying to blunt criticisms over amounts charged compared to others in the marketplace. Also, provider-based billing is often a source of consumer confusion, particularly when transparency is lacking.  We believe that the most effective way to defend prices is by developing, documenting and implementing a carefully considered and well-thought-out pricing methodology, with transparency, across all settings.

As an integral part of SunStone's solutions for this highly technical area, we invested in enhancements to our software Pretium®, which incorporates years of patient pricing experience into a web-based pricing solution. 

The time for providers to act is now and SunStone is prepared to assist clients meet this challenge. For additional information on SunStone's broad capabilities, please contact us at 717-678-3913 or via email at inquiries@sunstoneconsulting.com, or visit our website at www.sunstoneconsulting.com.

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SOURCE SunStone Consulting, LLC