Healthcare Financial Management Association calls Patient

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CHICAGO, March 07, 2024 (GLOBE NEWSWIRE) — Long an advocate for consumerism and price transparency in healthcare, the Healthcare Financial Management Association (HFMA) today called the latest report from Patient Rights Advocate (PRA) “irresponsible” and “incorrect.”

HFMA has maintained that to be effective, price transparency must offer clear information that is readily accessible to patients to enable them to make meaningful comparisons among providers. Transparency also requires a collaborative effort among providers, payers and other care purchasers to identify and develop the information and tools most useful to patients.

“PRA continues to release reports and scorecards that are an irresponsible mix of misleading, incomplete and incorrect,” said HFMA Director of Policy and Analysis Shawn Stack, a leading industry expert on federal price transparency regulations.

The latest PRA report asserts that only 34.5% of the 2,000 hospitals it reviewed are compliant with the federal price transparency regulations implemented in January 2021. PRA’s results contradict the Centers for Medicare & Medicaid Services (CMS) scorecard, which last scored compliance at 70% of hospitals.

“Beyond disagreeing with CMS’s assessment, we see PRA is consistently misinterpreting federal rules in each of its reports,” Stack said.

HFMA makes these comments in its role as a nonprofit, nonpartisan, nonlobbying association that for decades has provided finance and patient payment guidance to hospitals and health systems, as well as the White House, the IRS and others. HFMA is known for providing healthcare finance guidance that prioritizes the patient.

Key points of contention with regard to the PRA report include:

  • PRA is accusing many noncompliant hospitals of not including all their standard charge files related to accepted insurance plans. However, PRA assumes that when a hospital negotiates rates with a payer it secures negotiated rates with all plans and products under that umbrella. This is incorrect and leads to PRA’s overstatement of noncompliance. “This is reckless as it may misrepresent hospital compliance and unfairly impact a provider’s reputation and the patient’s comfort in seeking care,” Stack said.
  • PRA penalizes hospitals for not including plan-specific names in machine-readable files. Many providers currently include plan-specific contracted rates within the payer-specific data fields and are adjusting to separate these rates to comply with the new plan-specific data field by July 1, 2024. Currently, only the payer-specific data field is required in the MRF. In HFMA’s view, the new addition of the plan-specific data field will further clarify negotiated rates with payer products. However, “Any implication that the plan data field has always been mandatory, or that hospitals refuse to report these rates, is incorrect,” Stack said.
  • PRA does not demonstrate an understanding of the definition of machine-readable files, leading to additional confusion and misinterpretation of federal requirements. “A machine-readable file is designed to be easily processed and interpreted without the need for human intervention, while PRA seemingly thinks these files should have ‘human-readable access.’ Deviation from the standard understanding of MRFs is perplexing,” Stack said.
  • PRA disregards CMS’s mandated price estimator tool, saying it “fundamentally undermines the intent of the regulations,” assuming a goal of price transparency is to have one price for every service or procedure. Actual treatment can vary between patients given various individual complexities. “For the patient’s interest, it’s crucial to acknowledge this uncertainty upfront when considering the value and potential outcomes of healthcare interventions,” Stack said.
  • The report refers to an independent review and validation of the report by FireLight Health LLC and its founder. But the founder’s LinkedIn page says he “co-authored the report” in a feed filled with anti-hospital posts. “This hardly qualifies as an unbiased, independent review,” said Brad Dennison, HFMA director of editorial and policy affairs.

“HFMA encourages PRA Founder Cynthia Fisher to carefully consider her organization’s expertise, accuracy and role in the serious business of assessing hospital compliance and federal regulations,” said HFMA Senior Vice President of Professional Practice Richard Gundling. “And it’s important for PRA to operate with a level of transparency itself when it comes to the ambiguous nature of its sampling, analysis and validation processes.”

Those with questions about federal price transparency regulations and compliance are encouraged to contact Shawn Stack at [email protected] for more information.

About HFMA
The Healthcare Financial Management Association (HFMA) equips its more than 110,000 members to navigate a complex healthcare landscape. Finance professionals in the full range of work settings, including hospitals, health systems, physician practices and health plans, trust HFMA to provide the guidance and tools to help them lead their organizations, and the industry, forward. HFMA is a not-for-profit, nonpartisan organization that advances healthcare by collaborating with other key stakeholders to address industry challenges and providing guidance, education, practical tools and solutions, and thought leadership. We lead the financial management of healthcare.

Press inquiries should be directed to:
Brad Dennison
HFMA Director of Editorial & Policy Affairs
(630) 386-2945
[email protected]

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