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You are here > Home > Reading Lists > Finance & Reimbursement > Transparent Pricing for Retail Healthcare:
Critical Strategies

Transparent Pricing for Retail Healthcare: Critical Strategies to Secure a Competitive Advantage
Barbara Aubry, RN, CCM, CPC, CHCQM, Paul W. Moreno

Softbound Book + companion CD-ROM
Size: 8.5" x 11" plus CD-ROM
ISBN 1578398983
978-1578398980
HCPro Inc
December 2006
(click button below for the very best currently available price for this important resource)

Consumer-directed healthcare is already reshaping the market with transparent pricing, driving new legislation and a new level of competition. The only question that remains: will you lead the way or be left behind? The answer lies in how well you prepare. And with price competition already occurring in some markets, there’s no time for miscalculations. When it comes to setting prices for services and procedures:

  • What's your strategy?

  • Who decides how much to charge patients?

  • Are you charging too much—or not enough?

  • How can you tell?

This book and CD-ROM set will help you develop a pricing approach by showing you, step-by-step, how to:

  • identify true costs for the services and products you provide

  • price based on a number of factors, including your market

  • attract every potential patient in your market

  • use technology to complete the process and train your staff to educate consumers

You'll also get all the forms and tools you need to perform the analysis necessary to set costs appropriately, including cost worksheets. With these step-by-step strategies, you'll make the process smooth, painless, and ultimately profitable. Used together, this book and CD-ROM set will help you:

  • define pricing transparency from a financial standpoint
    understand the legislation rules and the current landscape (HSAs, CDHPs, ERISA)

  • implement quality tools and staff training solutions

  • remain competitive

  • educate your consumers

  • improve customer service and processes

  • develop strategic pricing initiatives and communication strategies

  • prepare for software advancements

  • recognize the difference between true cost and charges

  • make profitable choices with your service lines

  • select and prepare a pricing model that best suits your organization's unique needs, and more

It's a consumer's market and people are shopping for healthcare services based in larger part on what it will cost them out-of-pocket. And, new federal legislation will put your pricing information at their fingertips. To remain competitive, and profitable, you need to determine and truly understand your organization's costs and expenses.

 

Balancing price sensitivity with rising costs can be difficult and confusing. Most hospitals understand that across-the-board mark-ups do not yield the desired impact on net revenue, particularly for services charged to Medicare or Medicaid. Simply raising prices doesn’t work.

 

Healthcare providers need rate-setting strategies that result in sufficient net revenue to support acquiring new technologies and meeting the needs of an aging population. Providers also need to know how their prices compare with other facilities and must be ready to defend their pricing logic to government and consumer interests. This resource will help you to secure a competitive advantage by developing strategies to set procedure costs that are based on what the local market will bear. This resource kit is designed for:

  • PFS managers

  • Patient access managers

  • Revenue cycle managers

  • CFOs

  • Revenue cycle directors/managers

  • VPs of Finance

  • Billing/collection professionals

  • Managed care directors/professionals

  • Senior executives in acute care hospitals, ambulatory surgery centers, and physician practices

As today’s consumers pay more of their own healthcare costs, they are increasingly motivated to compare healthcare providers on the basis of both quality and cost. Government public disclosure (price transparency) initiatives have escalated and appear to be gathering momentum. As of June 1, 2006, the Centers for Medicaid and Medicare Services (CMS) began posting information on what Medicare pays for 30 of the most common elective procedures and other hospital admissions around the country. Furthermore, on Aug. 22, 2006, President Bush signed an executive order requesting federal agencies participate in healthcare transparency initiatives requiring them to gather and publish price and quality data by Jan. 1, 2007. In this climate of growing public scrutiny, healthcare providers are continually challenged to offer competitive prices while maintaining an acceptable bottom line.

You will need to identify appropriate market benchmarks. Analysis begins with a review of your current pricing methodologies, mark-up formulas, and payer mix and related payment mechanisms. Then you will want to identify appropriate market benchmarks and market-sensitive procedures in order to establish a competitive pricing position. Your goal is to assess the impact of price structure and proposed price changes on gross and net revenue. You will need to develop a strategic pricing model and assess the impact of proposed price changes and/or price re-structure and present our findings to management in a comprehensive analysis report.

This resource will help you to secure a competitive advantage by developing strategies to set procedure costs that are based on what the local market will bear.

Barbara Aubry, RN, CCM, CPC, CHCQM, is a regulatory analyst for 3M Health Information Systems. She has more than 20 years experience in the healthcare industry. She is responsible for analyzing CMS and other payer rules and regulations, continuous product improvement, marketing, and sales, and creating and maintaining data for specific 3M software applications. Paul W. Moreno is the project manager for strategic pricing with 3M Health Information Systems. He has more than 13 years of experience in the healthcare industry. His experience includes extensive work in the areas of pricing and analysis, in addition to mathematical modeling for financial impact and statistical sampling.

With more than 17 years of experience, HCPro, Inc. is a leading provider of integrated information, education, training, and consulting products and services in the vital areas of healthcare regulation and compliance. The company's mission is to meet the specialized informational, advisory, and educational needs of the healthcare industry. As an acknowledged industry authority in healthcare regulation and compliance, HCPro focuses on providing its clients assistance and expertise in the areas of accreditation, medical staff affairs, credentialing, privileging, medical record management, regulatory compliance, nursing, quality/patient safety, infection control, and workplace safety.

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