With the new pricing information disclosed, providers and payer may be impact in their negotiations and may be looking to take advantage of it as they negotiate new contracts.
Rate comparisons on the 70 shoppable services required by the rule may reshape provider/payer relationships and will open a new wide set of weapons to demand better contracts. Factor such as geography, services volume and quality will play an important role. Hospitals with negotiated rates lower than their competitors may seek to increase their rates on the basis that they are below market. Hospitals with rates higher than their competitors may feel market pressure to bring their rates down.
Payers will know whether their current negotiated rates with a hospital are low or high compared to that hospital’s rates for other payers and could use this information in future contracting discussions. They also may use the information to design narrow networks that take advantage of the information, and feature providers with lower rates.
The Transparency in coverage requirements will also impact negotiation processes and administrative decision, now that hospitals and payers publicized cost information have to match. This initial intelligence will be important to building a data-drive response and protecting provider/payer position in the marketplace.
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