WAYSTAR TREND ANALYSIS


Rising healthcare costs and increasing healthcare consumerism have placed price transparency in the spotlight for patients, providers and the government.

With the aim of increasing price transparency in healthcare, the Centers for Medicare and Medicaid Services (CMS) have mandated that hospitals publish meaningful price information for patients by January 1, 2021.

We recently asked healthcare providers what they think about price transparency and how they’re preparing to comply with the CMS mandate. Our findings are outlined below.

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Estimation accuracy and avoiding patient
confusion are paramount

When asked to rank what’s most important about providing cost estimates, three-quarters of respondents indicated “providing accurate estimates” as either the most or second-most important, with increasing revenue and minimizing resources ranking as lower priorities.

The majority of respondents indicated patient clarity as the greatest challenge, followed by impact to pricing or negotiation strategy and internal confusion about how to fulfill the mandate’s requirements. A quarter indicated that technological challenges were either their biggest or second-biggest obstacle.

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Discover the Waystar difference

We’ve aligned our most effective claims and denials solutions to help make your organization as productive as possible. Drawing on the latest tech and predictive analytics, your team will benefit from:

Some providers are concerned about the mandate's effects on their organization's finances

While many respondents indicated they expect no change to operating costs or staff productivity, a significant number expect somewhat—although not hugely—negative effects.

Organizations are making strides to meet the mandate

Regardless of differing opinions on the mandate’s effectiveness and practicality, most organizations who are subject to the CMS mandate are already taking steps to comply with the final rule. A smaller number are still evaluating and planning how to do so.

Efforts to meet the mandate are focused on education and technology

When asked what organizations are doing to prepare, most indicated they are investing in education and awareness for patients and training for staff. Half of respondents report that their organizations are building in-house price transparency tools, and just over a third are looking to third-party vendors. A similar number are tracking costs, and most respondents expect no change in staffing.

Price transparency is just one piece of a larger patient engagement strategy

Price transparency is important, but for most organizations, it’s a part of a larger patient engagement strategy to meet rising expectations on the part of the patient as a consumer.

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Key takeaways

    • Most everyone believes that patients deserve price transparency.
    • Some providers think the CMS mandate will help patients understand their bills, while others believe it will lead to greater patient confusion.
    • Most organizations who are subject to the mandate are taking steps to meet it.
    • Providing price transparency is important, but it’s just one component of a larger patient engagement and satisfaction strategy as patients expect more shoppable experiences.

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Survey methodology

In September 2020, Waystar surveyed 153 healthcare providers and sought insights from the company’s Strategic Advisory Board about price transparency, the CMS mandate’s expected effect on patients and their organizations, and what their organizations are doing to meet the mandate’s requirements.

Consensus: patients deserve price transparency

Nearly all respondents agree that patients have a right to know what their healthcare will cost ahead of time.


Most providers think patients are more likely to pay when they know the cost up front

The majority of respondents thought price transparency would also lead to higher rates of payment, although a quarter of respondents were unsure.

Opinions are divided on the effectiveness of the CMS mandate

Although nearly everyone supported the concept of price transparency, respondents disagreed on whether the mandate as currently laid out would actually help patients understand their financial responsibility, with most indicating that the mandate can lead to confusion.

Respondents were equally split as to whether the mandate would increase patient satisfaction, although very few thought it would decrease it.

PT-2020-Numbers.jpg

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Survey methodology

In September 2020, Waystar surveyed 153 healthcare providers and sought insights from the company’s Strategic Advisory Board about price transparency, the CMS mandate’s expected effect on patients and their organizations, and what their organizations are doing to meet the mandate’s requirements.

Consensus: patients deserve price transparency

Nearly all respondents agree that patients have a right to know what their healthcare will cost ahead of time.

Most providers think patients are more likely to pay when they know the cost up front

The majority of respondents thought price transparency would also lead to higher rates of payment, although a quarter of respondents were unsure.

Opinions are divided on the effectiveness of the CMS mandate

PT-2020-Numbers.jpg

Although nearly everyone supported the concept of price transparency, respondents disagreed on whether the mandate as currently laid out would actually help patients understand their financial responsibility, with most indicating that the mandate can lead to confusion.

Respondents were equally split as to whether the mandate would increase patient satisfaction, although very few thought it would decrease it.

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90%

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ANALYTICS PRO

ANALYTICS PEAK

Expanded claim lifecycle visibility through date tracking and proof of timely filing reports

PRO

+

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+

Dynamic, interactive, easy-to-use data visualization tools that allow for a deeper understanding of your rev cycle

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Your data unified on an end-to-end RCM platform

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Unlimited custom dashboards + reports with simple, yet robust BI tools to see and explore the data your way

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Ad-hoc data analysis tools for deeper insights into every facet of your revenue cycle

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Number of claims you follow up on monthly

<  >

Number of FTEs dedicated to payer follow-up

<  >

Fully loaded annual salary of medical biller

<  >

Total savings per year

$204,327

These numbers are for demonstration only and account for some assumptions. Contact us for a more comprehensive and customized savings estimate.

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At vero eos et accusamus

Sed ut perspiciatis unde omnis iste natus error sit voluptatem accusantium doloremque laudantium, totam rem aperiam, eaque ipsa quae ab illo inventore veritatis et quasi architecto beatae vitae dicta sunt explicabo.

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At vero eos et accusamus

Sed ut perspiciatis unde omnis iste natus error sit voluptatem accusantium doloremque laudantium, totam rem aperiam, eaque ipsa quae ab illo inventore veritatis et quasi architecto beatae vitae dicta sunt explicabo.

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Monthly claim volume

<  >

Current denial rate

<  >

Average claim value

<  >

Average number of appeal packages submitted per month

<  >

Total additional revenue recovered per year

$204,327

Total staff hours saved

These numbers are for demonstration only and account for some assumptions. Contact us for a more comprehensive and customized savings estimate.

At vero eos et accusamus

Sed ut perspiciatis unde omnis iste natus error sit voluptatem accusantium doloremque laudantium, totam rem aperiam, eaque ipsa quae ab illo inventore veritatis et quasi architecto beatae vitae dicta sunt explicabo.

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At vero eos et accusamus

Sed ut perspiciatis unde omnis iste natus error sit voluptatem accusantium doloremque laudantium, totam rem aperiam, eaque ipsa quae ab illo inventore veritatis et quasi architecto beatae vitae dicta sunt explicabo.

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Gross patient revenue

Net patient revenue

Patient mix (% Inpatient)

<  >

Payer Mix (% Commercial)

<  >

Payer mix (% Government)

<  >

Payer mix (% Other/self pay)

<  >

Note: The above values need add up to 100%

100%
$1.8M
$2.2M
$3.3M
$7.9M

OUTER RANGE: Likely cash impact range for a system of your size

INNER RANGE: Most probable range given your specific information

Benefit range accounts for benefit to be attained through missing charges, CPT coding errors and DRG assignment errors. This calculator is designed to be educational in nature based upon limited information. It is therefore not a guarantee of performance. 1 HFMA blog, 2016

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Join our clients in reducing rejections
and denials by payers

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