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Five Quality Measures for Medical Billing

By Jonathan Springston, Editor, Relias Media

Two physicians from Johns Hopkins have proposed five quality measures to improve medical billing.

“Given the wide variation in both pricing and collection practices by hospitals, measures of billing practices are needed. Billing quality is a type of medical quality,” the authors wrote in a recently published paper. “Incorporating measures of billing quality into reports of overall hospital quality could provide patients with a more complete assessment of a given medical center or practice. Recognizing that billing quality is valuable information, a more holistic and patient-centered set of outcomes also could be measured for benchmarking and performance improvement.”

These measures concern itemized bills written in plain English, price transparency, service quality, surprise bills, and litigation over unpaid bills. The physicians argue patients need to know what their service will cost before that service is rendered, and patients should be able to speak to someone promptly should questions arise. After care is rendered, these physicians believe patients should not receive surprise bills, and medical facilities should not sue patients to settle unpaid bills.

“The financial harm of medical care should not be separated from the clinical consequences of care, because both outcomes can have a major influence on the health and well-being of patients,” the authors wrote.

In offering these five quality metrics, the authors cited some troubling statistics reported in 2019 regarding the current state of U.S. medical billing practices. In one survey of 1,000 patients, 64% said they delayed or neglected medical care because they believed the cost would be too expensive.

In a related survey, about two-thirds of Americans said there are very worried or somewhat worried about unexpected medical bills. In another recent analysis, 48 of 135 Virginia hospitals reported garnishing wages of patients who had not paid medical bills in full. Further, just five of these facilities accounted for nearly 4,700 garnishment cases in 2017. In total, there were more than 20,000 lawsuits filed in Virginia in 2017 against patients for unpaid medical debt.

“This practice violates the historic mission of hospitals to be a safe refuge for individuals with illness or injuries, caring for all regardless of their ability to pay,” the authors argued. “Caring for people at a time when they are most vulnerable represents the best of the medical profession, but suing them to garnish wages represents a potentially harmful characteristic of modern healthcare.”

For much more information about each of these quality metrics individually and this recent paper specifically, be sure to check out Hospital Access Management.