Price transparency terms to know

Hospitals in the U.S. have been working hard to comply with federal hospital price transparency law ever since it went into effect on Jan. 1, 2021. And yet, there continues to be confusion about the law among health systems. Patient advocacy groups also have concerns that too many health systems are falling short of expectations.

In June 2022, the Centers for Medicare & Medicaid Services (CMS) issued its first fine for noncompliance on a health system in Georgia. This eliminates all doubt that large-sum penalties are a real threat to health systems that refuse to follow the law.

The moral of the story: If your hospital hasn’t been attentive enough to the matter of price transparency, now’s the time to encourage your leaders to get serious about compliance.

Be prepared: Price transparency isn’t an easy undertaking

While the idea of healthcare price transparency stems from good intentions, turning it into reality can be challenging, confusing and, at times, discouraging. Signs that hospitals are struggling to comply are everywhere. As of February 2022, hundreds of hospitals had received warnings from the CMS. That same month, PatientRightsAdvocate.org released a report showing that only 14.3% of 1,000 reviewed hospitals were following the price transparency law.

Patient rights groups say these findings mean the government isn’t enforcing compliance. But the Department of Health and Human Services says this isn’t true: They are sending warnings, and hospitals are taking steps to comply.

Meanwhile, the American Hospital Association (AHA) says reports like the one from Patient Rights Advocate are “misguided.” The AHA says “the only true arbiter” is the CMS, which they say has only found about 160 noncompliant hospitals as of June 2022 — a much smaller number than reported by patient rights groups.

Still, it can be disheartening to hear so many negative stories about how health systems are failing to follow the rules, especially when you know the rules are in place to protect patients. But don’t lose hope. Your team can succeed in this important undertaking by staying focused on a few key terms and using the resources you already have available to you.

The CMS highlights key terms in its guidance — learn them, use them

Words mean a lot. And in the legal arena, understanding the full meaning of words can help you follow the law. In fact, one of the main reasons hospitals have struggled to implement price transparency is that the law’s language can be hard to interpret.

The CMS mentions nine terms several times in its explanation of the law. As your marketing team works with hospital leaders to implement price transparency, make it a top priority to learn and understand these terms. To save your team some time, we reviewed the CMS’ website and pulled their definitions of these terms for you:

1. Clear. The CMS uses this adjective to describe the pricing information your hospital must provide online. In this case, “clear” means easily understood by everyday people.
2. Accessible. Along with “clear,” the CMS says your hospital’s online pricing information should also be accessible. Here, the adjective means easy to find and use. More specifically, it means your pricing information should be easy to find and use from your health system’s public website and through a search engine like Google with the fewest number of clicks.
3. File. According to the law, hospitals are required to provide “pricing information online about the items and services they provide in two ways.” One of those ways is through a “file” that contains “all items and services.” In this case, “file” means a digital computer file.
4. Comprehensive. This is one adjective the CMS uses to describe the above word “file.” It means complete.
5. Machine-readable. The CMS also uses this word to describe the above word “file.” Cornell Law School defines machine-readable as data in a format that can be easily processed by a computer without human intervention while ensuring no semantic meaning is lost. The CMS provides the following examples of machine-readable files: .XML, .JSON and .CSV.
6. Shoppable. The second way hospitals must provide pricing information is through a dedicated webpage on their public website. The law says this webpage must list “at least 300 shoppable services (or as many as the hospital provides if less than 300) that a healthcare consumer can schedule in advance.” In this case, the CMS says “shoppable” means any service that can be scheduled by a healthcare consumer in advance.
7. Consumer-friendly. The CMS uses this adjective to describe the list of shoppable services that must be displayed on your hospital’s public website. In this case, they’re asking hospitals to use plain language when creating the list of services, and they ask that you refer to the federal plain language guidelines for direction.
8. Searchable. Both the comprehensive, machine-readable file and the shoppable list of services should be “searchable.” The CMS describes this as “including searchable terms on the webpage such as price transparency.”
9. Prominent. The CMS says both pieces of pricing information should be “displayed prominently … in a prominent manner.” In this case, prominent means readily noticeable on your hospital’s website and “in a manner that clearly identifies the hospital location with which the information is associated.”

With these definitions in your toolbox, your team will be halfway through the price transparency race, able to make it to the finish line with confidence.

Feeling overwhelmed? Don’t forget about these resources

All this legal talk got you feeling overwhelmed? Don’t forget that you already have several resources you can turn to for help. Use them any time you need direction:

• Don’t start from scratch. Most hospitals already have a comprehensive pricing guide, usually called the chargemaster. Use that as your starting point, building onto it so that it fulfills the price transparency law’s standard charge requirements.
• The CMS answers frequently asked questions about hospital price transparency here. It’s where you can find more in-depth information about terms and requirements, including what standard charges hospitals must make public.
• If you can’t find the answers you need in the CMS’s FAQs guide, leverage your contacts within your hospital’s compliance and legal department. They’re your best source for legal questions that you need answered ASAP.
• Your hospital’s information technology department can help you understand any technology-specific requirements of the law.
• If you know of competitors who are already in compliance, turn to them for inspiration. You can find ideas to use on your site just by browsing their websites.

WG Content can help with price transparency messaging

Once you have your ducks in a row and have created content, think about turning to a partner like WG Content for a second opinion on plain language and search engine optimization (SEO). As experts on consumer-friendly language and SEO, we’re a go-to source for many hospital systems nationwide. We can help you put the final touches on your price transparency content so that it’s clear and accessible to everyone! Reach out to learn more about how our team can help your team with price transparency compliance.

Legal disclaimer: Just a heads up to our readers! The information provided in this article does not, and is not intended to, constitute legal advice. Instead, all information, content and materials in this article are for general informational purposes only.

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