High Stakes

Wanna Get Ahead of the Price Transparency Game? Don’t Just Check the Box.

Wanna Get Ahead of the Price Transparency Game? Don’t Just Check the Box.

A small earthquake shook attendees of the AHLA annual meeting this week in Boston.

Just as hundreds of healthcare lawyers were in the middle of discussing the latest legal issues facing providers, President Trump signed an executive order expanding existing price transparency policy.

As word got around the Boston Marriott, our Jarrard Inc. team in attendance kept hearing the same question: “What happens now that transparency policy is in the hands of executive branch rule-makers, not legislators?”

Industry insiders are doubtful the Executive Order will make a difference. Joe Paduda, principal at Health Strategy Associates and writer of the Managed Care Matters blog, said in a recent post that, “This is political grandstanding and will have zero impact on healthcare costs[…]” Still, he told us that he expects the process to be “disorganized and bumpy” and stakeholders should pay close attention.

In the meantime, providers need to get ahead of the curve of price transparency (and patient experience in general). Healthcare organizations have historically fallen back on the complexity of healthcare to limit the financial information that flows between providers and patients.

Kim Fox
Fox

Jarrard Inc. Partner and Regional Practice Lead Kim Fox is adamant that that defense is no longer effective.

“In healthcare we’ve been able to say that the cost of a service depends on many factors,” she said. “That’s not going to cut it anymore. I think you can at least know the cost of common procedures that people will shop for. We know that people are not going to shop for what to do in the middle of a heart attack.”

Listen to Fox’s comments about patient experience as it relates to price transparency:

What’s more likely is that patients will shop for elective and non-acute services such as joint replacements and colonoscopies, and they should be able to find out what those procedures cost.

Isaac Squyres
Squyres

Isaac Squyres, Jarrard Inc. Senior Vice President, agreed. He said that healthcare is never going to be simple, so it’s incumbent on providers “to try to make their point of view simple and straightforward and clear for people to understand.”

This is where healthcare organizations will diverge onto one of two paths. Smart ones will think about patients. The others will check boxes.

Providers still tend to focus on meeting – rather than exceeding – standards of compliance for issues of patient experience. Consider patient portals. CMS requires a minimum of half of patients to have access to their personal health information as part of the Promoting Interoperability Program for Medicare and Medicaid. However, only a fraction of patients actually use portals. Do an informal survey and it’s quickly apparent that one of the reasons for this gap is because patient portals aren’t user friendly. They check the boxes for Meaningful Use but aren’t meaningful for the patient to use.

Same thing for pricing. Posting the chargemaster may follow the letter of the law but doesn’t help anyone.

“There may be a tendency to stick to the letter of the law,” Squyres said from the AHLA conference. “But organizations that have a compelling message and meet consumers where they want to be met are more likely to take advantage of the situation and be well-positioned moving forward.”

Listen to Squyres’s comments about the relationship between patient experience and price transparency:

This means thinking about what will work for the patient in addition to what will check the legal boxes. Helping them understand what the terminology means, what the prices include and at least a range for what something will cost when possible.

Today, the vast majority of patients generally don’t price shop and don’t yet fully act like a consumer when it comes to healthcare and, even if they do, they don’t think it’ll help. That’s ok, Squyres said.

“The specific information may not be as important,” he said. “Patients just want to be able to get more information and more accurate information than they can get today. The real point is this: they want to feel more informed and more engaged.”

Bottom line: Organizations that are able to take the rule of the law, meet it, then provide something of actual value to the consumer will be the ones ahead in the game.

Or as Fox said, “Start somewhere.”

 

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