Becker's Hospital Review

11 CFO / FINANCE CMS finalizes hospital price transparency rule: 6 things to know By Ayla Ellison C MS issued a final rule Nov. 15 that requires hospitals to disclose the rates they negotiate with insurers begin- ning in 2021. The Trump administration also released a proposed rule that would require health plans to share price and cost-sharing information with members up front. Hospital price transparency final rule 1. Comprehensive "standard charges" file. The final rule requires hospitals to post their "standard charges" online in a machine-readable file. Under the definition adopted by CMS, standard charges include the following: 1) gross charges; 2) discounted cash prices; 3) payer-specific ne- gotiated charges; 4) de-identified minimum negotiated charges; and 5) de-identified maximum negotiated charges. Hospitals will be required to disclose the standard charges for all items and services, including supplies, facility fees and professional charges for employed physicians and other practitioners. 2. Publicize 300 "shoppable services." The final rule requires hospitals to post payer-specific negotiated rates online in a searchable and consumer-friendly manner for 300 services that patients are likely to shop around for. Sev- enty of the services are stipulated in the rule. Hospitals can choose the other 230 services they post online. 3. Penalties. Hospitals that fail to publish the negotiated rates online could be fined up to $300 per day. Health plan transparency proposal 4. Negotiated rates. The proposal would require health insurance companies and group health plans that cover employees to disclose on a public website their negoti- ated rates for in-network providers and allowed amounts paid for out-of-network providers. This requirement would promote competition in the healthcare industry, drive in- novation and support price-conscious decision-making, CMS said in a fact sheet on the proposed rule. 5. Transparency tool. Under the proposal, health insurers would be required to offer a transparency tool to provide members with personalized out-of-pocket cost information for all covered services in advance. "This requirement would empower consumers to shop and compare costs between specific providers before receiving care," CMS said. 6. Comments. There will be a 60-day public comment pe- riod on the proposed rule. n West Virginia hospital lays off 22% of staff amid cash flow crunch By Ayla Ellison W illiamson (W.Va.) Memorial Hospital is closing two clinics, laying off 35 employees and placing its intensive care unit on permanent diver- sion, according to the Williamson Daily News. e changes come two weeks aer the 76-bed hospital entered Chapter 11 bank- ruptcy protection, which occured Oct. 21. Williamson Memorial Hospital said it is facing financial troubles due to "extreme delays in collections from governmen- tal and third-party payers," according to the report. It's cash flow problem "appears to be due to an information system (EMR and billing system) conversion," the hospital said in a post on its Facebook page. e layoffs, which will affect roughly 22 percent of the hospital's 157 employees, and service cuts are among the steps the hospital is taking to improve its financial position. e hospital, owned by Williamson-based Mingo Health Partners, may still close by the end of the year, according to a Worker Adjustment and Retraining Act Notification letter obtained in October 2019 by the Williamson Daily News. "is is to advise you that Williamson Memorial Hospital may permanently close its hospital facility. If it occurs, the exact date of the closing is unknown at this time but should take place approximately on or before Dec. 21, 2019," the letter read, according to the report. "Current ownership is using its best efforts to re- structure the debt through Chapter 11 bankruptcy and keep the hospital operat- ing under new management or find a new owner that will have the resources to keep the hospital open in the future." n Humana to lay off 800+ employees By Morgan Haefner M ore than 800 people working at Humana will lose their jobs, as the health insurer said Oct. 28 it will cut its payroll by 2 percent by the end of 2019, according to the Courier Journal. Although a Humana spokesperson did not specify where the layoffs will be made, they're expected to affect employees across the health insurer's operations in several states. When asked by the Courier Journal why the layoffs will occur, Humana spokesperson Kate Marx said the company is "creating new jobs that support our health-focused strategy and business operating model and phasing out positions that are no longer aligned." Humana said it anticipates its 12,000-employ- ee base in Louisville will remain the same. The insurer encouraged those affected by the lay- offs to apply to some 2,000 open positions na- tionwide. Those affected by the layoffs — pro- jected to be about 832 of Humana's 41,600 employees — will be provided severance "or monetary pay based on years of service with the company," according to the report. n

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