America's healthcare delivery system is ailing and many feel "under attack" by a multitude of seemingly insurmountable problems: a growing uninsured population, rising consumer discontent with high prices for drugs and services, hospitals grappling with issues of interoperability, patient safety and privacy, quality measures and the call for pricing transparency.
With all of these pressures, one would believe that there is no light at the end of the tunnel. But there is. Especially when it comes to how one hospital, in particular, is dealing effectively with transparent pricing.
First, the Darkness
Although chargemasters provide a detailed list price for all services offered by providers, these systems are complex and most consumers would have difficulty deciphering the pricing information without a comprehensive understanding of charging and billing systems.
To compensate, many providers have created pricing books or matrices that provide case prices and apply the terms of the contract to provide consumers with a summary of out of pocket expenses.
Unfortunately, these tools are maintained manually. They are very labor intensive and result in significant margins of error. Additionally, there is typically no way to monitor the information provided to consumers and compare supplied information to the actual bill produced after service is rendered.
Drivers Behind Pricing Transparency
In June 2006, HFMA released the Patient Friendly Billing® report on consumerism in healthcare. This report outlines pricing transparency as a key area of focus for providers.
From the providers' standpoint, making pricing information available for customers (formerly known as patients) is necessary to meet the rising tide of consumerism in healthcare and increased number of uninsured or under-insured patients.
On the other hand, from the customers' perspective, they want more information and don't want to be surprised when the bill arrives. This patient dissatisfaction is driving the provider to become more proactive in their approach to the delivery of information. Patients no longer want to wait and see pricing until the insurance pays or they receive an explanation of benefits.
So, what does all this mean to healthcare providers? They can take the "wait and see" approach to determine how their state will mandate publishing prices. They can allow their state or insurance companies to post prices for them. Or, they can take a proactive approach and make this information available to their customers, but without burdening their staff with more manual processes.
Now the Light – A Case Study in Florida
One such solution, offered by Accuro Healthcare Solutions, is CarePricer®. This Web-based tool allows healthcare organizations to provide accurate pricing transparency by utilizing provider specific historical claim data and current pricing from the chargemaster.
These statistically valid "service categories," which are basically pseudo-claims, can be used by the provider to furnish general information to consumers or to create patient specific estimates for shoppers during pre-registration or the scheduling of services.
At a well-known hospital in Jacksonville, Fla., estimates are being provided for customers, courtesy of CarePricer, as physicians schedule services. Patient demographic and insurance information is made available via HL7 and a virtual private network (VPN). Financial counselors use CarePricer to create patient specific estimates, which are then priced against the providers' contracts.
Whether it is special pricing for the uninsured population or a managed care contract, CarePricer applies the applicable terms and produces the expected payment information. Patient specific insurance benefits can then be applied to produce a patient friendly "advance EOB."
According to the management team, they have found that providing accurate, transparent up-front pricing information helps improve patient satisfaction by eliminating surprises when the bill arrives. They have also found that patients whose treatment was estimated upfront are more likely to pay for the care they received, hence decreasing the overall cost to collect.
CarePricer has also increased efficiencies at this Florida hospital. Prior to using CarePricer, estimates were created manually, which could take from 40 minutes to four hours, depending upon the complexity of the service being scheduled. Now, estimates typically require less than 10 minutes to complete. This has allowed the staff to provide over 30 percent more patient specific estimates without increasing resources.
Proactive Approach to Mandated Pricing
Mandated pricing is inevitable. If providers are not currently required by their states to furnish pricing information to consumers, it is only a matter of time before legislation makes this an eventuality.
The proactive approach in providing helpful information to consumers is a win-win situation for both the consumer and the provider. The benefits can include increasing patient satisfaction, improving collections at the point of service, decreasing bad debt and the cost to collect, and controlling the information provided to patients to ensure accuracy.
Now with CarePricer, you can meet transparent pricing requirements quickly, easily and accurately.
Julie Waddell, CarePricer Product Owner
