August 13, 2019

Pricing Transparency: Your questions answered by TWG

Matt Perron

Our blog post this week focuses on the recent executive order on pricing transparency. Two of our experts, Andrew Wade and Matt Perron, ask each other a few questions on what this could mean for healthcare organizations and what they could be doing to prepare. Andrew is a Revenue Cycle expert while Matt’s focus is on Patient Access.

Andrew Wade (AW): I’ll start with the obvious question – What can we do to prepare for this?

Matt Perron (MP): In reading the article, one thing that immediately jumped out was this quote –

“Providers and payers will be ordered to give patients estimates for out-of-pocket costs for procedures in advance of the procedure, according to the order.”

Providing estimates to patients isn’t anything new and most organizations are doing that already, but this could mean a much broader implementation on where you use estimates today. Its common that only a few targeted services or procedures will have templates defined to create easy estimates. I think its important to really think about where you use estimates today and what the roadmap looks like to make them as widely available as possible.

Creating that roadmap is no small task either. You need to pull in members from across the organization (patient access, CBO, department leadership, IT etc.) to form a cross-functional team. Also, training users to give estimates or route patients appropriately is often the last step in deploying estimates. Before that, validation that the estimates you provide are accurate and configuration to make standard, easy-to-use templates can take many months. It can be a challenge all its own. For some organizations though, just implementing estimates is still on their to-do list and I think now is more important than ever to get that done.

AW: How will this impact your patient access departments?

MP: A lot of the organizations I’ve worked with that use estimates today, only give access to them to certain teams or groups of individuals. In general, that seems to work fine but it does come with inherent challenges. For one, there are often many places a patient can call so its imperative to know how to direct patients to the right people if they are asking for a price estimate. Also, having centralized groups handle estimates may make it more difficult to handle some of the nuances of different areas/procedures so having pre-built templates and a road map to expand them is even more important.

Finally, we need to always keep in mind the patient experience when having these estimate conversations as they can be challenging. As Rebecca touched on in a previous post on compassionate collections, its important to coach staff on how to have these conversations with the patients and give them samples of typical interactions so they can practice and empower the patient as much as possible.

MP: What, if any, involvement will be needed from the billing office to assist in this transition?

AW: There will actually be quite a bit of involvement. A significant part of providing accurate estimates means having consistently accurate charge capture from all services lines in the organization and by having all contracts built out in either the existing EHR or in a contract vendor system.

Accurate charge capture allows estimate modules to understand what has been charged historically for similar procedures and contracts build allows estimates modules to appropriately determine what payors would pay for each procedure and what will be passed on to the patient.

Inaccurate build or data could cause a discrepancy between the provided estimate and the actual cost.

Furthermore, customer service representatives will need to be educated on how to appropriately respond to inquiries and questions regarding estimates from patients.

MP: When this comes to fruition, there is likely to be some confusion and anger around established prices. What can organizations do to get ahead of this?

AW: The key thing is to get ahead of this. Organizations should be communicating with existing patients on what changes they are likely to see to reduce the possible shock. For new patients, there should be materials provided by the organization to help educate patients on the new processes.

In addition to planned communication materials, staff should be educated on the changes coming and what it will mean for the patients. The worst scenario that could happen is patients requesting estimates and having questions for staff members unprepared to answer them. Consider this, if you’re buying a car and one dealer can answer every question you have about the services and price while another dealer cannot, you’re likely not going to the dealer incapable of answering your questions. It’s the same in a hospital setting.

This policy forces organizations to emphasize great customer service from the moment the patient contacts the organization.

There are still plenty of unknowns when it comes to the legislation related to pricing transparency and the things we talked about here are really just the tip of the iceberg. If you would like to talk more about patient estimates or how the recent executive order may impact you, please reach out to Matt Perron and Andrew Wade. We’d love to chat!

Matt Perron

Manager, Patient Access

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