Price Transparency: The Patient is the New Payer
The cost of healthcare continues to rise, and the payers are continuing to shift more of the cost share to the patient in the form of High Deductible Health Plans (HDHPs). The increased financial responsibility of the patient has sparked the growth of consumerism in healthcare and has established the patient as the “new payer”. Smart consumers are now comparison shopping and demanding price transparency from providers. Patients want to know how much their healthcare services are going to cost them, but surveys show that hospitals are not ready for price transparency.
So, what can hospitals do to position themselves to meet the demands of the new payer? Hospitals must be equipped properly and have the needed resources to be able to provide price information to patients. Having tools such as a price estimator, a pricing hotline, a link on the hospital’s website, and a mobile app would help hospitals prepare for price transparency demands and regulatory mandates.
This is only an Estimate
Patients have the right to know how much a service or procedure is going to cost them, but in healthcare, determining the exact price prior to services being rendered is quite challenging. If the patient has no insurance, then the self-pay discount can be applied to the total charges and the price is estimated based on what is expected to be done. A patient with insurance is much more complicated as there are hundreds of different benefit plans and the patient’s responsibility is usually based on the contracted allowable which differs depending on the provider/payer agreement. This is where technology saves the day. An estimator tool loads the provider’s contract terms as well as the provider’s chargemaster and then automates the estimation process to determine the patient’s financial responsibility. It is important when presenting a patient with an estimate that the patient understands that it is only an estimate.
Estimates are based on the information provided, at the time of the estimate, on what services are being done. If additional services are performed, then the patient is going to owe more than the original estimate. Providers need to incorporate specific wording on the estimate to set the expectation with the patient as well as enable the patient to make an informed decision about whether the services are affordable. It is also important to make it easy for a patient to be able to obtain an estimate.
One option for patients to obtain an estimate can be using a pricing hotline. Hospitals should establish a pricing hotline where patients can call in and speak to a patient care representative about the services they need. The patient provides the procedure information based on what the physician has ordered and then the estimate is created and relayed to the patient. Pricing hotlines can be attended or unattended, but either way a response to the patient must be in a timely manner to ensure good customer service and to keep the patient from going elsewhere.
Link on Website
Another option for patients to obtain an estimate can be from a link on the hospital’s website. The patient would click on the link for an estimate and then be able to either see a pricing list on the top performed procedures or could enter a specific procedure and see that pricing. Once again, for good customer service, the link should allow patients to be able to request an estimate if the service/procedure they need is not listed or cannot be found on the website. The request would be an email to a patient service representative who would then create the estimate and, depending on the patient preference, either email or call the patient back to relay the pricing information.
With most patients having their own smart device, a mobile app for pricing is yet another way for hospitals to make it easy for patients to obtain pricing estimates. This creates a great customer experience allowing the patients to find pricing information at their convenience: anytime, anywhere.
If hospitals want to remain competitive in the market, they will need to make pricing transparency a priority; what prices do they share, how do they share them, and how do they make it easy for the patients to obtain? Hospitals need to implement a pricing transparency strategy and equip themselves with the necessary tools for meeting consumer demand and regulatory mandates. Ready or not, the “new payer” is here!