Dealing with Price Transparency

Hospital prices are under increased scrutiny by Federal agencies, patients, and the public in general, at a time when hospital operating margins are weak. Hospitals in some states are required to post prices for some, or all, procedures under new consumer-driven “transparency” regulations.  Hospitals must have the tools to become more sophisticated in their approach to establishing prices. They need to optimize revenue and maintain compliance while staying within the constraints of these “new” consumer-driven healthcare initiatives, and third party contractual limitations.

Key Objectives and Benefits

• Monitor charge data at the CPT/HCPCS code level of competitor or peer group hospitals.
  

• Negotiate managed care contracts from a position of strength and knowledge through an understanding of the hospital’s price competitiveness as compared to other area hospitals.
  

• Establish charges for new procedures and programs.
  

• Determine how a hospital’s current charge mark-up factor compares to the mark-up factor of its competitors or selected peer group.
  

• Identify CPT/HCPCS codes that the Peer Group has reported, while your facility has not. (PRC's Code Omission Table)
  

• Have the charge data from the selected Peer Group Hospitals brought into a report containing your Charge Master for easy comparisons.
  

• PRC will provide the client with a functional ‘lookup’ application that allows for peer group charges and Medicare reimbursements to be viewed for individual CPT/HCPCS codes. This application will allow the user to enter a CPT/HCPCS to view comparative pricing data and Medicare reimbursement rates.
  

An Overview of PRC's

Strategic Pricing Analysis

Rapidly rising costs in Healthcare are causing the “market” to become more consumer driven. Patients are comparing prices and are requesting quotes in advance. Regulations requiring publicly posted pricing are being implemented, and all of these issues are encouraging price comparisons.

PRC’s Strategic Pricing Analysis (SPA) has been designed to provide your facility with the tools and data required to perform a charge comparison with a selected Peer Group.  Upon completion of the “SPA”, you will receive several reports/analyses which compare your charges and volumes with each Peer Group Hospitals’ charges and volumes.   Additionally, PRC will provide Client with a functional ‘lookup’ application that allows for Peer Group charges and Medicare reimbursements to be viewed for individual CPT/HCPCS codes.  This application will allow the user to enter a CPT/HCPCS to view comparative pricing data and Medicare reimbursement rates.