Price Transparency Rule: First Penalties Issued

Almost 18 months after the Centers for Medicare and Medicaid Services (CMS) new price transparency rule went into effect, the organization issued its first of many fines.

Hospitals are now required to provide a comprehensive machine-readable list of services as well as prices listed on their websites. This recent ruling affirms the government’s commitment to making it easier for consumers to shop and compare prices across health systems. Now, a consumer should be able to estimate the cost of care before going to a specific hospital for services.

Who was fined and how much?

An Atlanta-based hospital system was fined close to $1 million. CMS stated that neither a “consumer-friendly list of standard charges was found”, nor a machine-readable file.

CMS set a minimum CMP (Civil Monetary Penalty) of $300 a day for smaller hospitals with less than 30 beds. As well as a penalty of $10/bed a day for hospitals with 30+ beds. These are not to exceed a maximum daily dollar amount of $5,500. For a full year of noncompliance, the minimum to the max range for total penalties is $109,500 – $2,007,500 per hospital.

You can learn more by viewing this document for frequently asked questions from CMS’ website.

What does that mean for you?

A recent study by the Journal of the American Medical Association shows that only about 14% of hospitals are fully complying with this new federal law.

If CMS concludes that your hospital is non-compliant it may take any of the following actions and stated that “generally but not necessarily will occur in the following order”.

  • Provide a written warning notice to the hospital of the specific violations
  • Request a Corrective Action Plan (CAP)
  • Impose a Civil Monetary Penalty (CMP)

If CMS issues a request for a hospital to submit a CAP, it must be submitted by the date specified in the request and must also…

  1. Specify the process the hospital will take to fix the issues
  2. List the timeframe by which the above will be completed

If a hospital fails to respond to CMS’ request to submit a CAP or comply with requirements, the organization may impose a CMP. 

CMS has already issued around 350 warning notices to hospitals that violate the ruling. If you did not receive a notice, but know that your system does not accurately display price information we suggest that your team, whether internally or with your digital partner, implement amendments to your digital properties as soon as possible. 

The Challenge

So, if this is such a big issue, why are only 14% of hospitals following the rule?

From a patient’s perspective, it’s simple, “quickly show me how much I’ll pay for x, y, and z”. However, it’s not so easy for a hospital to implement.

There are a handful of reasons why organizations may not be posting pricing fast enough. The biggest we see is discrepancies and variations in costs for patient A versus patient B, even if they both receive the same treatment.

In order to protect the hospital, each service will factor in a certain amount of risk (depending on the situation), and therefore, the “price tag” of a particular service could be elevated. Prices for services can also change frequently depending on when agreements with each payor start and end as well as factors like who is incurring the cost (employer, insurer, patient, etc). This requires consistent updating in order to keep the list up to par with CMS’ ruling.

How to follow the ruling?

Two ways to post standard charges:

1. ) Machine Readable File

A single machine-readable digital file that contains: gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges.

2.) Consumer-friendly Display of Shoppable Services

Display all “shoppable services” with ancillary services and provide discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges. It’s crucial to note, that each of these services must also contain a plain language description.

To learn more about what exactly your hospital needs to provide, visit CMS’  help or resources page.

An ending note

In summary, many organizations are not investing beyond the bare minimum in price transparency requirements. 

If your team does not already have pricing listed on your website you’ll need to act quickly.

Cost of Healthcare Drives Industry Transformation

Early in the new year, it’s customary to take some time to reflect on the past, set goals for the present, and plan for the future.  

Our team spent time reflecting on the significant changes we’ve seen over the last decade in healthcare that have directly impacted the landscape today. One of the most prominent and the main catalyst that we’ll cover is the cost of care

In this article, we’ll review the 3 major trends that have materialized from the continued rise in the cost of healthcare and how they’re directly shaping the industry.

Healthcare costs continue to climb

In the past decade, consumers paid more for healthcare than ever before. In fact, Americans spent nearly twice as much in 2019 as they did in 1980. And yes, this data does account for inflation. The observed dollar amount was adjusted appropriately in order to compare apples to apples. It may not surprise you that the cost of healthcare has increased year after year. After all, we have more advanced technology, treatment plans, drug production, and consumer engagement platforms. But all of those niceties are not the main driver of the cost influx. Instead, insurance is the primary offender.

The shocking fact is that…

“insurance costs have grown by 740% since 1984”

CNBC stated that the average American paid about $3,400 for insurance alone in 2018. While a household spent nearly $5,000 per person on healthcare in the same year.

It is truly no wonder that medical bills are the number one cause of bankruptcies in the U.S.A. This alone helps to contribute to the lack of trust in healthcare systems, a colossal issue today.

It’s also worth noting that in 2020, annual spending on healthcare was estimated to be around $3.65 trillion or $11,172 per person in the U.S.A. This total is larger than the gross domestic product of Mexico, Canada, and Spain combined. It is also, by a wide margin, the highest annual healthcare spending in the developed world

This climb in cost over the past 40 years laid fertile ground for change and new entrants to quickly grow.

#1 Bigger is better; mergers and acquisitions

Over the past decade, we’ve seen large healthcare systems, drug makers, and insurers begin and close mergers. 

In 2018, CVS Health and Aetna closed a $70 billion deal. The nation’s largest pharmacy chain and health insurer combined to instill their towering goal of ”transforming healthcare delivery for the better”.

Locally, we’ve seen Wellmont Health System and Mountain States Health Alliance come together to form, client, Ballad Health. Intermountain Healthcare and SCL Health are planning to merge in early 2022 to form an $11 billion health system. As well as two of Michigan’s largest providers Spectrum and Beaumont Health will combine forces and create a $12.9 billionmega-merger”.

This trend of healthcare system consolidation is not only an act to gain new efficiencies but also to reduce the cost of operation. Let’s hope that we see these mergers translate to cost savings for the consumer. 

#2 Digital front door comes to stage

The buzzword “digital front door” started circulating in healthcare circles in 2017. Around this time the industry started to understand the importance of creating and implementing strategies that leverage the use of technology to create better and more connected customer experiences. 

Often a digitally connected healthcare customer experience will include tools such as:

  • Well-designed and transparent appointment scheduling.
  • Access to scheduled or on-demand telehealth visits.
  • Digital service channels via live and AI-based chat.
  • Easy access to the information a patient or their family needs.

The digital front door strategy is all about taking the time to truly understand what your customers need most and taking the steps to meet those needs. One big need, you might have guessed, is cost. 

We’ve seen healthcare systems combat rising costs by offering more channels for consumers to interact with their brand and where most convenient. For example, AI-based chat can help concerned patients quickly find the information they need at less cost and 24/7.

#3 New players enter the healthcare space

Companies like Apple, Google, and Amazon set a new standard when they created and launched revolutionary digital customer experiences. Now consumers have high expectations for optimal user experience and seamless functionality with any product or brand, no matter the industry. 

Over the past decade, we’ve seen the deities of digital enter the healthcare space to disrupt the industry. In 2018, healthcare experienced a “wild-west” style shoot-out for who would partner up and enter the market. Many large tech companies accomplished their goals by quickly merging with strategic elites.

Google hired a healthcare CEO to organize its health initiatives. Apple began testing the market with wearables and EHRs. In addition, companies like Lemonaid empowered patients by “treating you better”.

Never before have consumers had such a strong voice or choice. These new entrants are offering consumers new and engaging ways to manage their healthcare.

For example:

  • Scheduling a quick telehealth appointment with Amazon.
  • Seeking dietary advice from a NutriSense glucose-monitoring skin patch.
  • Getting a physical while grocery shopping at Walmart.

Fortunately, these companies are offering affordable services and tackling the rising cost of healthcare head-on.

What’s to come?

It’s no big surprise that healthcare consumers are fed up with paying outrageous prices and struggling to manage care. We’ve seen some movement to correct the pressing pain points but more must be done. 

On the bright side, there’s no time like the present. The sooner that health systems can…

…the sooner they can captivate consumers and increase lifetime value.

HMPS 2021 Takeaways

Earlier this month, our team sponsored, exhibited, and presented at the Healthcare Marketing & Physician Strategies Summit in Miami. It was refreshing to be back in person and see familiar faces. 

There were many noteworthy speakers and trending topics covered throughout the week. We decided to put together a list of major HMPS takeaways and themes from the content presented for those who were unable to attend this year.

#1 Communication is “key”

The importance of communication was brought to light last year. Consumers and the general public were constantly looking for answers. Yesterday’s news was no longer relevant and we spent hours sifting through articles only to find outdated information.

HMPS dedicates one out of its five tracks strictly to communication. We attended numerous sessions that provided suggestions on how to do so efficiently and effectively without inundating an audience. Overall the presenters advised that you take a natural, authentic approach to content creation and delivery. Do not make the consumption of news more complicated than it needs to be. Make the best use of the systems you have.

Some organizations took a unique approach to communication that was very notable.

LCMC Health, took a celebratory and welcoming approach to combat the cold, impersonal lines during the vaccine rollout. The Louisiana-based organization made the vaccination process fun for all. Their team added Mardi-Gras-themed floor stickers, photobooths, and free concerts to liven spirits.

Hunterdon Healthcare had a member from the C-Suite team provide quick and personal updates for patients via daily Facebook videos.

#2 Consumers expect more from healthcare

This should come as no surprise. We know that consumers are expecting healthcare to deliver experiences as the big tech companies do. 

You’re falling behind if your organization cannot deliver a customer-centric experience that delivers real value and a lasting impression.

Two ways your organization can get started:

#1. Create a customer journey map

We surveyed several nationally ranked hospitals and found that only 18% indicated that they had completed a customer journey map. Problems arise when digital content is created from the inside out, without data and input from the end-user. Why spend hundreds of thousands of dollars on a consumer-facing product that does not meet the needs of the customer? 

Journey mapping can help you strategically set goals and expectations as well as more accurately understand what your customers need. Understanding the importance of customer journey mapping and how your consumers can directly benefit should be a critical step in your digital road mapping strategy.

customer journey mapping screenshots

It’s fair to say that the experience of living through a pandemic has forever changed consumer behavior, especially in healthcare. Your patients demand quality, affordability, but what else?

From our research, our team uncovered 3 top trends that can help your team prioritize customers’ needs on the web.

Time is precious

We found that the pandemic has exacerbated an interesting trend. Customers are more likely to be transactional, and they want transactions to happen immediately

Perfect the details

Did you know that today’s customers are more likely to have shorter sessions—specifically, sessions of 1-3 pageviews? Therefore, your customers are likely to miss important content that is 1-3+ clicks from your product page content.

bar chart graphic showing that the percentage of sessions with 1-3 pageviews are increasing

Connection is key

If a customer enters your site on a non-product page, such as an informational coronavirus page that has updates and relevant information, and is able to navigate to another area of the site within 3 page views, they are roughly 30-40 times more likely to convert.

So even as your customer’s willingness to hunt for information continues to decrease, how well you connect the disparate areas of your site can increase overall conversions for the site

Example of connecting a physicians profile to other parts of the site (ie locations)

#3 The future of telehealth

Since the major onset of telehealth, we’ve seen countless direct benefits. In fact, Becker’s Hospital Review reported that 85.5% of Americans said telehealth has “made it easier to get the care they need.”

However, as we emerge from the pandemic, telehealth should not go to the wayside, rather organizations need to expand beyond virtual urgent care. McKinsey & Company reported that around 40% of consumers stated that they will continue to use telehealth going forward—up from 11% prior to COVID-19.

graphic that says "40% of consumers stated they will continue to use telehealth"

In addition, research shows that between 40-60% of consumers are interested in broader virtual health solutions i.e. “digital front door” as well as lower-cost health plans.

But how should healthcare systems plan for the next chapter of virtual healthcare? 

Our team suggests that any digital plan forward should be rooted in data by firstly understanding your consumers and their needs. This can be done through customer journey mapping exercises, user interviews, persona development, and more. The collected data should then be used to drive the creation of seamless consumer experiences across the board and will help to optimize the future of your organization’s virtual care longevity.

#4 Chatbots are here to stay

Why not aim for a patient-oriented approach to reduce the strain on your limited resources?

All sounds fantastic! But, have you and your team thoroughly thought through your organization’s specific needs?

A well-thought-out and implemented chatbot can seamlessly integrate into an organization’s digital consumer experience. However, a not-so-great one can lead to serious consumer discontent. That’s why our UX team advises that before getting too excited about a chatbot, your team first answers…

“What is the main problem we’re trying to solve for the consumer?”

In order to create a proper chatbot, you will need to be very clear and upfront about its capabilities. Otherwise, some patients will automatically expect to “chat” and have a full range of flexibility. However, when the chatbot is unable to do so, will become frustrated. We suggest that your team plans to complete an in-depth UX exercise prior to implementation. This includes:

  • Settling on a goal
  • Mapping out personas
  • Crafting user flows
  • Teasing out the language (and possibly synonyms your chatbot will use)

Quick tip: if you’re trying to help a patient find specific content you may be better off investing in content strategy and internal search. 

Example of what an in-depth user experience exercise can look like

What’s next?

COVID has helped to accelerate digital transformation and consumer experiences for healthcare. As we emerge from the pandemic it’s imperative that organizations continue to forge stronger connections with patients.

Our team can help.

We help healthcare organizations identify the right digital strategies and create products that …

  • infuse control
  • transparency
  • and choice

… into the consumer healthcare experience.

Contact us to learn how our clients are tackling some of healthcare’s biggest challenges. 

4 Lessons on Digital Transformation for Healthcare

Most will agree when I say that last year was a whirlwind. We saw our “normal” become not-so-normal in a matter of a few days.

Our team worked tirelessly with clients to get digital products to market that were, at that point, needed yesterday. In a way, COVID-19 lit a fire under many healthcare organizations. It helped us all realize how quickly we could spin up new essential, customer-facing products.

Today, we’re taking a step back from last year to give you an update of what’s going on in healthcare. 

Below are 4 critical lessons we’ve learned in the past year about where large providers are today with respect to digital transformation.

What is digital transformation?

Let’s start off with the basics. What exactly is digital transformation and specifially in the context of healthcare?

Simply put, digital transformation is the proces of taking a buisiness, that’s less digitally oriented, and strategically using digital technology to make a consumer experience better.

This does not mean that an organization should just create better digital tools for customers, the end. A large part of the “transformation” piece is building out tech platforms to support those digital customer interactions.

**Free tip: For more information about digital transformation, check out this video. In it, our leaders sit down and share what digitial transformation means for healthcare in detail. Or this video that outlines what healthcare providers can do to get ready for digital transformation.

#1 Healthcare providers are heavily investing in digital transformation

As an industry, healthcare has historically been slower to adopt digital. However, over the past couple of years, we’ve seen an increasing number of healthcare organizations actively seek digital transformation and invest in discrete digital capabilities.

Surely, investing in digital is a crucial competitive advantage considering Accenture’s recent report, How COVID-19 Will Permanently Alter Patient Behavior, that shares 60% of patients want to use technology more for communicating with healthcare providers and managing their conditions.

And, according to a Business Group on Health Survey, 80% of employers think virtual care will have a big impact on how people get care moving forward (up from 50% in 2018) and 53% of large employers say that implementing more virtual care solutions are their top initiative for 2021.

**Free tip: If your organization hasn’t invested in mobile engagement you might value this webinar recording. In it, Ballad Health shares how they built an EHR-integrated, patient-facing mobile application that delivers an all-in-one experience to customers.

#2 Although, providers have made progress in discrete digital capabilities, they lack a truly connected cohesive customer experience

Recent research shows that healthcare providers have made a lot of progress in discrete digital capabilities. For example:

  • Implementing ratings and reviews
  • Launching mobile applications
  • Standing up online billing

However, many have done very little to truly connect all digital features into a cohesive customer experience.

Although we see digital taking off, much of this work in healthcare organizations are siloed and therefore creates pain points for the end consumer. If healthcare providers are going to win more customers in today’s digital landscape, they will need to stop seeing digital as a collection of features. Rather, it’s essential to start seeing it as the way to build a better and more connected customer experience.

#3 Mobile is the next critical platform

We’ve seen an increased rate of willingness to use mobile apps to manage healthcare conditions.

44% of patients used new devices or apps to help manage conditions remotely during COVID-19 and 70% expect that the use of technology will be more prominent in their lives over the next 3 years.

While we believe it is still early in the adoption curve, many healthcare systems are choosing to take control of their mobile patient experience by building a branded, proprietary mobile application that directly integrates with their EHR.

Whatever your path, having a focused mobile customer engagement strategy will be critical for health systems looking to better serve the growing mobile native population.

#4 Customer journey mapping: couldn’t be more necessary but very few are doing it

Journey mapping is an activity that purposefully helps organizations better understand their customers’ needs, pain points, and overall how the end customer interacts with the organization’s digital tools and brand.

We recently surveyed 11 nationally ranked children’s hospitals to better understand their progress on achieving digital transformation. When we asked about journey mapping, 2 out of the 11 indicated that they had completed a full, cross-functional journey map.

“Customers experience roadblocks, dead ends and frustration in their journey. The more friction we put in front of potential customers, the less likely they are to complete the journey.” – Forbes

Why spend thousands of dollars on a consumer-facing product that does not meet the needs of the customer? Not only can journey mapping help you strategically set goals and expectations, but also truly understand what your customers need.

**Free tip: Do you know the very basics of how your patients engage with you on the web? This guide is full of questions, exercises, free tools, and more! Download our free guide today to make the most out of your web analytics platform and learn how your website stacks up against our clients.

COVID-19 Puts Technology Roadmaps on a Fast Track

Ask the Expert, with Bryce Cannon, President of Modea

// By Jane Weber Brubaker //

The pandemic has taken a toll on every aspect of our lives for the past several months. As health systems have scrambled to meet the needs of their communities, technology projects that may have been nice to have down the road before the coronavirus are now mission-critical.

We sat down with Bryce Cannon, president of Modea, in Blacksburg, Virginia. Modea is a healthcare technology, web development, and data analytics consulting firm. Our conversation was about where we are today as an industry, and where things need to go to realize the potential of digital transformation. Cannon shared his perspectives on advancements driven by COVID-19, and the challenges healthcare still must overcome to solidify strong relationships built during these challenging times.

Read the full article here.