Ophthalmology practices have long been at a disadvantage when negotiating their contracts with group health plans and insurers. Without access to reliable data about how their compensation stacked up against competitors for the same services, the only comparisons came from word-of-mouth.
In 2020, though, that changed. New federal rules went into effect that required payers to disclose their in-network provider negotiated rates, historical out-of-network allowed amounts, and drug pricing information to the public. All healthcare providers — including ophthalmology practices — gained access to vast amounts of price transparency data.
Still, it seems few ophthalmologists are aware that this asset is available to them; fewer still appear to actually use it. It’s possible to derive actionable insights from the enormous price transparency data sets and once in the hands of providers, those insights can help them improve payment rates, get insight into expanding service line and locations, and offer more affordable care for their patients. Accessing the data for information that can be easily understood requires expertise, but the benefits can easily outweigh the effort.
Four Key Benefits of Price Transparency Data
Price transparency data can help strengthen ophthalmology practices in many ways, including:
Improving negotiations with payers
Some ophthalmology practices do not negotiate with payers because they’re not big enough to have bargaining power. For those that are big enough, they’re often ill-equipped to negotiate their contracts without evidence to demonstrate the health plan or insurer is under-paying them. Price transparency data can provide that evidence, giving ophthalmologists a clear view of their position in the market in comparison to their competitors. Using that information, practices can negotiate with their contracted payers for better rates or expand to new plans and insurers. Ophthalmologists can then choose to contract with those plans instead of, or in addition to, their current plans.
Gaining a competitive advantage in their market
Patients often comparison shop for specialty care, so it’s important for ophthalmologists to ensure their prices align with those of their competitors. Price transparency data offers ophthalmology practices the insights they need to properly price their services to successfully compete in their market and demonstrate to patients their commitment to providing affordable care.
Reducing risk when introducing new service lines
Introducing new service lines is a common way to grow practice revenue, but it comes with risk. Imagine you’re an ophthalmologist interested in purchasing an expensive new piece of equipment that allows your practice to offer new services. Before going all-in, you can consult price transparency data to learn what plans and insurers in your market are paying for that kind of procedure. This information, coupled with an understanding of the number of procedures being performed, will help predict the return on your investment in that equipment before you buy.
Guiding decisions about geographic expansion
Expanding into new regions or states can grow revenue, but without an understanding of payment rates for services, it can be a risky shot in the dark. Ophthalmologist can use price transparency data to gauge how their services would be paid in different markets. Based on the trends in reimbursement for ophthalmology services in those areas, practices can make informed decisions about whether to invest in that expansion.
The Challenges of Navigating Price Transparency Data
Price transparency data holds essential insights for ophthalmology practices — but accessing those insights isn’t possible for most healthcare providers on their own.
Even the largest healthcare systems in the country struggle to derive insights from public price transparency data, and the typical physician practice lacks the experience, expertise, and time to even begin to address the hurdles involved in exploring the data.
Price transparency data is comprised of thousands of files that require expertise to mine for rates relevant to specific services and procedures in a region, as well as an advanced analytics team to clean and normalize the data.
While most ophthalmology practices don’t have the expertise or resources to address these types of technical and analytic challenges, they can still harness the power of price transparency data by working with a trusted data solutions partner.
Choosing the Right Data Consulting Partner
Ophthalmologists have no shortage of consultants to choose from to engage in this work. Generally, these consultants fall into one of two camps:
A data provider can build a database from publicly available price transparency data, link it to a search engine, then turn it over to the ophthalmology practice to use as they see fit. But that means an internal staff member must run structured query language (SQL) commands on the database — a capability that most practice staff do not have. There’s also no guarantee that the data in the database has been verified well or often enough to deliver reliable insights.
A data solutions partner can provide a practice with:
- analytic-ready data that’s constantly cleaned to ensure quality
- custom analytic tools and a user-friendly interface that even non-technical staff can navigate
- ·one-on-one consultation that’s rooted in the partner’s expertise in healthcare markets and policy landscapes
- a deep understanding of the practice’s goals to inform custom strategies for success.
Making Price Transparency Data Work for Your Practice
To truly capitalize on the value that price transparency data offers, ophthalmology practices should engage a data solutions partner as soon as possible. Early adopters will have a first-mover advantage in negotiating the best rates with plans and payers, offering the most competitive prices to patients, exploring new service lines, and expanding into new territories. Practices that wait will find far fewer opportunities to gain similar advantages in the marketplace.
With more than five decades of experience in data analysis and healthcare policy, Mathematica is a powerful data solutions partner for specialty providers, including ophthalmology practices. We offer comprehensive access to data from national and regional health plans, provider-specific Medicare rates, and Medicare and Medicaid claims data. Our healthcare data experts help transform massive amounts of price transparency data into structured, trusted insights.
These insights are now more accessible to ophthalmology practices. Healio PRICE Compass, a Payer Rate Insights Comparison Engine developed by Mathematica, is an innovative pricing transparency tool that allows physicians to see the contracted rates for all payers within their market via a user-friendly dashboard, providing the leverage they need to negotiate the best reimbursement rates.
Learn more about how Healio PRICE Compass can fuel your practice’s growth.
