Introduction
The price transparency rule was enacted by the federal government seeking all health facilities to have a health plan that includes disclosing the negotiated prices that must be paid to the physician and the prices they offer to their clients. It is a rule enacted to ensure that there are accessible competitive prices that can be done in comparison with other state agencies to reach a mitigated state of the relative market values (Gondi et al., 2021). The rule is vital in ensuring no consumer exploitation in the market.
Rule enforcement strategy
The Centers for Medicare and Medicaid Services use several strategies to enforce price transparency. First, it puts rules ensuring that all the hospitals have to publish the item cost and services that must be publicized on their websites. These hospitals must also possess a readable digital machine with standard charges for items and services. The rule enforcement strategy that the CMS uses also entails follow-up on the standard charge, including at least three hundred shoppable services that consumers must schedule in advance (Gondi et al., 2021). The hospital is also to ensure that they have an online price estimator tool that evaluates the standard charges. Other strategies that have been used entail having an enforcement plan that includes taking complaints from individuals and reviewing the non-compliance analysis, which might result in auditing the hospital website.
Legal risk and liabilities
Based on the price transparency rule, it is ideal to note that the risk of a lack of price transparency in any hospital adds up to the closure of the hospital, warning, and fining. This depicts that the risk involved might bring along liabilities such as 300 dollars penalty for non-compliance in larger hospitals. The three hundred fine rate remains constant for a hospital having less than thirty beds. At the same time, the penalty might rise by ten percent for those with additional beds, adding to a maximum penalty of around five thousand five hundred dollars (Glied, 2021). Other risks might accrue due to the possible impact on competitive harm, including having warning letters and correctional action plans. This shows that there is a need for any hospital to evade this risk as well as the liabilities that come along with this non-compliance issue.
Hospital compliance preparation
According to the CSM, any hospital has to post a friendly display of the standard charges for at least three hundred shoppable items. This can entail gross and discounted price charges (Gondi et al., 2021). The hospital also has to put a table showing the items not accessible, the display prompt, services offered, and prices.
The rule of transparency applies to the federally owned and operated hospital, requiring the hospital to disclose the standard charges and the services provided. This shows that the rule of transparency applies such that hospital items and services the hospital provides have standard charges and must be listed regarding the data elements.
These services can be improved by providing a robust codified federal insurer rule (Gondi et al., 2021). This is in line with the hospital having a fully advanced explanation benefit which will ensure the implementation of price transparency.
Impact on the health system
The two potential drawbacks for the privately owned hospital are that the enhanced transparency can increase the price due to imperfect substitutes (Zhang et al., 2020). Besides, the increased demand will override the transparency effects in terms of competition.
For the federally owned hospital, this price transparency will help the patients be informed of their rights which might not be the case for private companies (Zhang et al., 2020). More so, there will be reduced competition as the federally owned hospitals will have a price comparison relative to the market value.
References
Glied, S. (2021). Price transparency—promise and peril. JAMA, 325(15), 1496-1497. Retrieved from: https://jamanetwork.com/journals/jama/fullarticle/2778818
Gondi, S., Beckman, A. L., Ofoje, A. A., Hinkes, P., & McWilliams, J. M. (2021). Early hospital compliance with federal requirements for price transparency. JAMA Internal Medicine, 181(10), 1396–1397. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8204253/
Zhang, A., Prang, K. H., Devlin, N., Scott, A., & Kelaher, M. (2020). The impact of price transparency on consumers and providers: a scoping review. Health Policy, 124(8), 819-825. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0168851020301433
write