SunStone Consulting, LLC™ Price Transparency and the Development of Rational Pricing
HARRISBURG, Pa., June 11, 2019 /PRNewswire/ — SunStone Consulting is pleased to announce major enhancements to its consultative pricing solutions and improvements to its proprietary software Pretium®. These changes, along with firm Principal Kevin F. Brennan, CPA, FHFMA vast experience with National HFMA and 35 years of CFO experience enables SunStone to assist providers navigate today’s challenging pricing environment.
For years the industry has been under attack over amounts charged for services, often completely ignoring the much lower actual payments received for those very services. The TIME magazine article in 2013, “Bitter Pill“, ignited a wave of negative press and confusion that continues today. While the Healthcare Financial Management Association (“HFMA”) has responded with advice on rational pricing, releasing a Price Transparency Task Force Report in 2014, it failed to stop government requirements to disclose Charge Description Masters (“CDM”) effective January 1, 2019 in a machine-readable format. The Center for Medicare and Medicaid Services (“CMS”) has also explored ways to incentivize beneficiaries to utilize the most clinically appropriate site by launching a website allowing beneficiaries to calculate out of pocket costs at various settings for the same procedure.
Prior to joining SunStone, Kevin was the CFO of Geisinger Health System and is the 2018-2019 national chairman of HFMA. He participates on HFMA’s Chargemaster Alternatives for Medicare Payment (“CHAMP”) Committee; the work group examining potential future Medicare reimbursement formulas devoid of charge inputs. Through this approach, alternative solutions are being explored for a dozen reimbursable items that utilize charges today in calculating reimbursement, as well as evaluating the implications and requirements of a future state. Kevin was also a member of HFMA’s Price Transparency Task Force that released recommendations and a consumer guide in 2014 that are still relevant today.
SunStone has been fully immersed in the subject of patient pricing for over 30 years and more recently, has been integrally involved in helping providers with rational and defensible pricing, including being published in industry guidance like HFM. Increasingly, providers are finding themselves in a defensive position trying to blunt criticisms over amounts charged compared to others in the marketplace. Also, provider-based billing is often a source of consumer confusion, particularly when transparency is lacking. We believe that the most effective way to defend prices is by developing, documenting and implementing a carefully considered and well-thought-out pricing methodology, with transparency, across all settings.
As an integral part of SunStone’s solutions for this highly technical area, SunStone invested in enhancements to its’ software Pretium®, which incorporates years of patient pricing experience into a web-based pricing solution.
For additional information on SunStone’s broad capabilities, please contact us at 717-678-3913 or via email at inquiries@sunstoneconsulting.com, or visit our website at www.sunstoneconsulting.com.
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