Consumer Group Pressures New Mexico Governor to Enforce Price Transparency
September 5, 2022
Happy Labor Day!
A local newspaper just ran a story that highlights San Juan Regional Medical Center, and not in a good way:
The hospital responded to the article by saying,
HPS conducted a third-party audit of San Juan Regional's price transparency files and concluded that the consumer group was correct.
San Juan uses Experian for its price estimator tool. This price estimator is a closed-system tool that requires the patient's membership information to receive a payer-specific out-of-pocket cost estimate. Therefore, HPS was unable to validate the accuracy of the estimates. CMS is considering a change to the price estimator requirements, requiring an Open System approach. The Open System approach is more consistent with the spirit of the ACA and will enable CMS to audit the estimates. [see open system example in a New Mexico hospital provided by HPS]
When reviewing the machine-readable file, HPS was able to determine that the hospital is not compliant, specifically:
- no payer negotiated rates are present
- no payer min/max rates are present
- no cash prices are listed
- no industry-specific codes (e.g., CPT/HCPCS or revenue codes) are present
A leading hospital public relations firm calculates a "direct hit" negative newspaper article like this can cause six-figure damage to a hospital's reputation.
HPS has helped numerous hospitals construct a fully-compliant machine-readable file, even if they're already contracted with another vendor for the price estimator tool. It's a small price to avoid a newspaper article like this, or worse yet, be identified by CMS as a price transparency offender.
As always, a consultation with me or one of my partners is free. Just click on this link to schedule a call: go.oncehub.com/ricklouie