In terms of making prices transparent to hospital patients, “we’re really in the first innings as an industry in making self-searchable information available to consumers,” says Bill Krause, vice president and general manager of connected consumer health at Nashville-based Change Healthcare. Krause says it is important for hospitals to properly execute the following:
• Do everything possible to limit billing surprises. If patients believe any cost information was withheld from them, they are highly likely to be dissatisfied. “That’s the first thing hospitals really need to work on,” Krause says.
Many people find healthcare information confusing, and this can result in some surprises. “But it’s important to note that emergency department services are not considered shoppable,” Krause notes. “When you are having a heart attack or a stroke, you don’t dig out your insurance information to make sure you understand your financial responsibility.”
Current price transparency rules focus heavily on “shoppable” services, those that are nonemergent that can be planned for in advance, such as diagnostic tests or knee replacement surgery.
• Make price information available in many different formats. Posting prices on the hospital website is not nearly enough. Call centers, patient portals, and in-person financial counselors all are needed, too, depending on patient preferences. “Some people will want to speak to staff, and others will want a self-service option,” Krause observes.
• Convey that even the best price estimate is only that — an estimate. Price estimates are based only on the information staff know before service. It is especially hard to identify the final prices for complex tests and procedures. “For everyday labs and office visits, there’s low variability. Beyond that, it becomes more difficult,” Kraus laments.
Communicating some kind of disclaimer that is understandable to patients is important to avoid confusion.
• Consider using two different approaches, depending on the complexity of the service. Posted prices are for shoppable services that generally are simple (e.g., an ultrasound or blood work). “That category is advancing much faster in terms of a retail consumer approach. There’s more price certainty,” Krause explains.
Surgeries and other complicated care are going to require more intensive support. “Some hospitals are pushing out a retail model, and a more complex care model,” Krause says.
Even in the retail world, some purchases, such as a pair of sneakers, are straightforward, while others, such as buying a new car, are far more complex. “Look outside healthcare for good examples,” Krause suggests. “Retail clinics and innovator models throughout the country are showing the way.”
More complex care is enigmatic, from a financial standpoint, with greater financial burdens for patients. “That side needs to be pursued differently,” Krause offers.
To be really successful with price transparency, says Krause, “hospitals need to take a more end-to-end view of the patient’s financial journey as opposed to a point in time.”