Established in 2012, Hospital Pricing Specialists (HPS) has become an indispensable player in helping hospitals across the U.S. navigate the complexities of revenue cycle management, pricing transparency, and payer negotiations. Led by Rick Louie, Managing Director and Founder, the company has served as a boutique data analytics firm specializing in hospital pricing optimization and creating comprehensive solutions for hospitals to meet the now-demanding CMS (Centers for Medicare & Medicaid Services) price transparency regulations.
HPS focuses on assisting hospitals with their revenue cycle, the financial process that involves managing the flow of money from patient care services to final payments. By leveraging their vast database of hospital pricing information and payer rates, this data analytics for healthcare companies helps hospitals optimize their pricing strategies, which, in turn, ensures they are competitive in their market and compliant with CMS regulations.
Rick explains, “We collect and analyze two core datasets: the gross charges or the list price for each service and the payment rates from various insurance companies. This allows us to conduct in-depth pricing studies for hospitals, compare their prices with competitors, and help them align their pricing models to optimize revenue. In doing so, we ensure that hospitals aren’t leaving money on the table and are getting reimbursed appropriately by insurers.”
With over 1,200 successful pricing projects, HPS’ ability to utilize data is one of their biggest assets. The company acquires publicly available claims data from hospitals across the U.S., creating a rich database that captures both pricing information and payer rates. This data is then used to help hospitals perform pricing studies, benchmarking their services against local competitors and adjusting their prices to remain competitive.
The Managing Director explains with an example: “In many hospital contracts, reimbursement is based on a percent of the hospital’s gross charge. For instance, if a hospital charges $1,000 for a service and a competitor charges $2,000 for the same service, the hospital could lose out on significant revenue because they are being reimbursed a lower percentage of their charge. Through our pricing studies, we help hospitals adjust these prices to optimize revenue, ensuring prices are consistent with the current market levels while not exceeding payer increase thresholds.”
In addition to pricing optimization, HPS plays a vital role in helping hospitals with payer negotiations. With the intricate mix of contracts between hospitals and insurers, where services may be reimbursed under different models - such as fee-for-service, percent-of-charge, or case rates - HPS has partnered with DeductibleData to build a comprehensive database of payer rates to offer hospitals valuable insights. Rick explains: “Every payer has a different way of reimbursing hospitals, and these methods can vary widely depending on the service provided. By benchmarking a hospital’s payer contracts against competitors, we provide actionable data that hospitals can use in negotiations to secure better reimbursement rates, demonstrating the value they provide to insurers.”
Since 2019, hospitals have faced increasingly stringent regulations under the CMS price transparency rules. Hospitals are required to post their pricing online and provide a tool to help patients estimate their out-of-pocket costs. This transparency is meant to empower patients, allowing them to make more informed decisions about their healthcare.
Rick highlights HPS’ role in this evolving landscape: “We offer a fully outsourced solution that helps hospitals comply with CMS transparency requirements. Our flagship tool, EZCOST®, simplifies the price transparency process by providing an easy-to-use cost estimator for patients. We also ensure that hospitals have compliant, machine-readable files of their contracted rates, so they can avoid the financial penalties that come with non-compliance.”
HPS works with hundreds of hospitals across the country, helping them fulfill these critical transparency requirements. By providing tools that meet these complex regulations, HPS is empowering hospitals to not only meet their legal obligations but also enhance their relationships with patients, offering them clear, understandable pricing information.
Rick’s experience in the healthcare sector spans over 25 years. Before founding HPS in 2012, Louie was involved in several successful startups, including one that focused on healthcare informatics and price benchmarking for major U.S. automakers. His deep expertise in healthcare pricing and reimbursement, combined with his background in business intelligence and consulting, has positioned HPS as a leader in the field. “Our mission,” the founder emphasizes, “is to make sure that hospitals are fairly reimbursed and transparent with their pricing, which ultimately benefits both the hospital and the patient.”
HPS offers a full suite of services apart from its EZCOST®, designed to address the pricing, reimbursement, and compliance needs of hospitals. These include MOAD®, a machine-readable file tool for CMS-required contracted rate data; Transparent Pricing Review (TPR), which ensures defensible and competitive pricing strategies; Comprehensive Chargemaster Review, which maintains accurate hospital pricing for better reimbursement; and Payer Market Analysis (PMA), a reporting tool that analyzes for a specific payer where a hospital’s rates compare to its competitors to better understand which services to either preserve or negotiate better rates. Through these products, HPS not only helps hospitals optimize pricing and reimbursement but also ensures they remain competitive and compliant in today’s complex healthcare environment.
As price transparency laws continue to evolve, the need for accurate pricing data and compliant solutions will only increase. Hospital Pricing Specialists is well-positioned to meet these challenges head-on, providing hospitals with the tools they need to thrive in this new era of healthcare transparency.
“We’ve built a company that hospitals can trust to deliver results,” says Rick. “With over 60 years of combined senior executive expertise and a proven track record, we’re excited to continue helping hospitals navigate the complexities of the healthcare system and ensure that both hospitals and patients are getting the value they deserve.”
Media Contact
Name: Randi Brantner
Email: randi@hospitalpricingspecialists.com
