Access to price transparency data has been transformative for Cincinnati Children’s Hospital. That was the biggest takeaway from a recent conversation we had with Tiffany Walberg, director of pricing and reimbursement analysis at Cincinnati Children’s.
She’s been using pricing data provided by Healthcare Data Analytics for more than a year now; in that time, she’s identified four major use cases for the pricing data. Let’s take a look at what they are and how having access to this data lets Tiffany be more impactful in her job.
Background: The Data Itself
At present, HDA provides Tiffany and her team pricing data for 20 hospitals, including some adult hospitals in Ohio and some children’s hospitals around the United States. The Cincinnati Children’s team tracks negotiated rates and gross charges for a select set of CPT codes at these hospitals, as well as cash prices.
After more than a year of access to the data, Tiffany has discovered that it provides significant value in four distinct use cases:
- Researching anecdotal claims about prices (often from patients and practitioners in various divisions)
- Powering negotiations with payers
- Setting prices on emerging services
- Tracking price trends
Let’s take a closer look at each.
1. Researching Anecdotal Pricing Claims to More Confidently Set Prices
Anyone who’s worked in a role like Tiffany’s knows that patients occasionally complain about prices. In some cases, those complaints come with assertions that other hospitals offer lower prices for the same service in the same setting. Providers, too, often hear murmurings of what prices are elsewhere – in some cases because they work in multiple facilities.
Before HDA, Tiffany said, she and her team had limited options available for investigating those assertions. While she and her team have long used pricing data from private data sources, it often isn’t granular enough for precision.
HDA’s data, on the other hand, includes both CPT codes and service descriptions, as well as chargemaster rates and negotiated rates. That offers much better insight. For context, she explained that some services that share the same CPT code (various diagnostic services, for instance) might have prices that range from as little as $30 to as much as $500, thus making the aggregated data useless in trying to assess what other hospitals were charging.
With the HDA-powered database, though, she can easily search by CPT and service description, identify the exact service she wants to compare prices for, and see, instantly, what each of the 20 hospitals that Cincinnati Children’s tracks is paid by provider plan.
“I can’t stress enough how much more convenient this is,” Tiffany said.
With comprehensive data from similar hospitals at her fingertips, Tiffany can quickly provide essential context to the team that sets prices, who can then confidently set an appropriate price.
2. Fueling Payer Negotiations
A second use case the team at Cincinnati Children’s has found for HDA’s price transparency data is powering negotiations with payers. In one recent instance, a payer wanted to change what it was reimbursing Cincinnati Children’s.
The negotiations team turned to Tiffany to understand what that payer had negotiated with other hospitals. With just a few minutes of research, Tiffany was able to pull not only that information but also the reimbursement rates of exchange plans at various hospitals.
With this information in hand, the negotiations team was able to more confidently negotiate with the payer.
Tiffany expects this use case to become increasingly important in the future, as some studies suggest more payers are using hospitals’ listed cash rates to guide their own rate negotiations.
3. Setting Prices on Emerging Services
Another way Tiffany expects to use HDA’s data is to inform price setting on emerging services, like the Covid-19 vaccines as federally mandated coverage requirements expire.
Understanding chargemaster rates and how other hospitals are reimbursed will be key to not only ensuring appropriate rates but also encouraging the kind of population-level inoculation that can serve broader public health goals.
4. Tracking Price Trends Year over Year
Like all businesses, hospitals are constantly juggling costs and expenses to make the bottom line work. As inflation and labor shortages squeeze hospital margins, Tiffany noted that she’s eager to track prices year over year to see what the general trends are.
For example, are hospitals increasing chargemaster rates on shoppable services like diagnostics and room rates? If so, by how much? And how are they handling these increases?
She also noted that this kind of data can help when looking at specific competitors; for example, keeping price increases below a competitor’s might feed into a larger strategy to increase market share for a specific procedure or service.
Access to Data Makes for Faster, More Confident Price Decisions
The lack of transparency in healthcare pricing has hurt hospitals as much as it’s hurt consumers. HDA is excited to be able to facilitate faster, more confident pricing decisions and empower hospitals to negotiate prices more confidently with payers.
In the coming months, HDA aims to offer even more data to its customers. Insurance companies have been required to publish their pricing data since last summer; as they comply, HDA will make more and more of that information available to its customers.
If you’re interested in discovering how healthcare price transparency data can transform operations at your hospital, please get in touch. We’d be happy to set you up with a free trial so you can experience the power of our data yourself.