New Health Care Transparency Requirements: Policy Health Brief

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Table of Contents

Introduction
Summary of the Policy Brief
Relation toAPRN Practice
Weaknesses of the Issue
Recommendations for Issue
Conclusion
References

Introduction

Advocacy is an integral part of nursing practice in safeguarding patients’ rights and providing high-quality health care. Advanced Practice Registered Nurses (APRN) are tasked with advocating for strategies that positively influence health care services. Advanced practice nurses are also required to intensely appraise current policies in healthcare and their effect on consumers. This essay aims to explore the ‘New Health Care Transparency Requirements: Recommendations for Optimizing Pricing Data to Reduce System Costs’ policy health brief. The health brief targets journalists and policymakers who have an interest in the healthcare sector. Access to this data is helpful to policymakers for identifying individuals and entities responsible for increasing the cost of health care.

Summary of the Policy Brief

The primary policy brief is that many hospitals do not comply with the newly established transparency requirements. In most cases, the published data is usually hidden, so it is inaccessible to the relevant users (Patel, 2020). By 2027, healthcare costs are forecasted to account for 20%of the United States economy, therefore reducing minimum wages and economic competitiveness (New health care transparency requirements,2021). Further, citizens below 65 years old are the most significant drivers of health care costs.

Understanding what insurance companies pay to the hospitals is essential for health services researchers to regulate pricing to protect the insured parties. This information is also helpful to health care purchasers, especially employers, who choose affordable plans that provide quality care (Hearing, 2019).

Relation toAPRN Practice

The recommendations for optimizing pricing data to lower system costs play a significant role in APRN. The reason is that these recommendations are tasked with advocating for patients’ rights (Schmidt, 2021). In most cases, there is information asymmetry in the healthcare industry, mainly disservice the consumers. Therefore, an APRN should support policies that aim to provide quality health care to patients without being extorted in terms of prices for the services.

Weaknesses of the Issue

Lack of Compliance

Many hospitals do not fully comply with the regulations on transparency. For this reason, most hospitals fail to publish data for nearly all the services commissioned by the Centers for Medicare & Medicaid Services (CMS). In most cases, some hospitals that have reported a part of

their insurer-specific rates have failed to include rates agreed upon by other insurers. For-profit healthcare institutions hide such information for various reasons, including tax evasion.

Lack of Uniformity

For the few hospitals that comply with the regulations, they publish inconsistent data. The data published does not have any uniformity, and elements are displayed and defined differently. For example, there is no primary method for presenting data on prices. Therefore, users are compelled to visit each hospital website to collect and analyze data. In addition, hospitals publish this data using different formats in excel andhence making it difficult for analysis and comparison.

Lack of Quality Data

Many hospitals publish poor-quality data in terms of missing fields and inconsistent values. Hospitals may intentionally obstruct the data from the relevant analysis. For instance, a hospital may report its data set,with all the variables staffed into a single column, making the data not useful. Furthermore, other hospitals use their hospital-generated codes instead

of using Diagnosis-related Group (DRG) codes or the Current ProceduralTerminology (CPT) (Aiello & Roddy, 2017). Additionally, hospitals omit data dictionaries when publishing pricing data, making it difficult to interpret data.

Recommendations for Issue

Enhancing Oversight and Enforcement

The report argues that the current penalty ofnon-compliance with transparency is very low. It is recommended that thesentence be increased from $300 to $550 per day. This strategy would helpincrease the number of hospitals publishing their pricing data. Further, the CMS should regularly audit hospital websites for easy monitoring of compliance with the regulations. The state should also help by providing significantleverage for hospitals’ compliance with both the federal and state laws.

Standardizing the Data

The issue of lack of uniformity in publishing pricing data can be resolved by standardizing the data published by all hospitals and healthcare institutions. The CMS should specify how the hospitals should present their data. For instance, the CMS should provide atemplate format to be used by all the hospitals. Using a standard template formula would make it easy to collect and analyze data from different hospitals without visiting each hospitals website.

Developing Data Connections

To solve the issue of poor-quality data, the CMS should develop data connections. This strategy would make it easy to extract pricing discounts and hence improve the quality of data reported. The hospitals shouldalso be required to report their prices as a percentage, using a centralized repository offered by the CMS. The hospitals should also be coerced to use the Diagnosis-related Group (DRG) codes or the Current Procedural Terminology and include a data dictionary when publishing data on pricing.

Advocating for the Policy Implementation

As an Advanced Practice Registered Nurse (APRN), I would advocate for policy implementation by participating in the policy review. This process involves collecting data to enhance the policy and analyze the possible outcomes (15 nursing specialties, 2019). I would also make use of evidence-based research for data collection in order to make meaningful decisions. To advocate for the policy implementation, I would also join a professional nursing organization.As an APRN, I can volunteer to attend all the policy implementation meetings and other related activities.

Conclusion

The policy brief can enhance the employers’ market power while promoting regulatory oversights. The policy brief also gives healthcare services researchers a wide range of information for informing the policy. According to the policy brief, the data published on the hospital websites lack uniformity, and it is of low quality. Some recommendations for solving these issues include enhancing oversight and enforcement, standardizing the data, and developing data connections.

References

Aiello, F. A., & Roddy, S. P. (2017). Inpatient coding and the diagnosis-related group. Journal of vascular surgery, 66(5), 1621-1623.

Hearing on “Improving drug pricing transparency and lowering prices for American consumers”. (2019). House Committee on Energy & Commerce. Web.

New health care transparency requirements: Recommendations for optimizing pricing data to reduce system costs. (2021). Robert Wood Johnson Foundation.

Patel, K. N. (2020). Hospital charge and pricing transparency (Publication No. 28031139) [Doctoral dissertation, The University of Alabama at Birmingham]. ProQuest.

15 nursing specialties to explore with an Advanced Nursing degree. (2019). Capella University.

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