Improving Price Transparency With IT

Health IT Outcomes | August 11, 2015

Providers are leveraging technology and enhancing education efforts earlier in the treatment process to better inform patients of their financial responsibility while gaining a competitive business edge.

Up until recently, many consumers never thought of conducting comparison shopping for healthcare services. That’s no longer the case. A fast-changing healthcare environment with higher deductibles and increased out-of-pocket expenses is causing consumers to comparison shop and providers to rethink how — and when — they communicate with patients about their financial responsibilities.

Help is out there. In fact, just this spring, the American Hospital Association released a price transparency toolkit to help providers effectively educate consumers while also meeting requirements of the Affordable Care Act (ACA). Meanwhile, 42 states now report information on hospital charges and payment rates and make that information available to the public. In addition, CMS posts on its website average hospital-specific charges per patient and average Medicare payments for the most common diagnosis-related groups, as well as 30 ambulatory procedures.

Rehab Associates of Central Virginia is one facility where leaders decided to leverage technology and best practices to keep patients informed from the get-go. Recently Jessica Wright, COO, shared her insights on how the provider is effectively using technology to improve price transparency.

Q: Why is price transparency so important?

A: Patients have transitioned to consumers in today’s healthcare environment. We routinely have patients shop before they make a decision to choose Rehab Associates to provide their physical therapy. With this in mind, it is imperative that we provide clear information to help patients understand what their out-of-pocket responsibility will be. If we don’t provide this information — or if it is ambiguous — patients are more likely to choose a provider who will.

Q: How did your organization start down the path to price transparency?

A: The first step is being able to verify a patient’s benefits prior to their appointment. If we do not have good information about the type of coverage the patient has, it is impossible for us to paint a real picture of what their costs will be. We use ZirMed’s Eligibility Verification solution to streamline this process as much as possible. This solution provides an electronic means to verify benefits for multiple payers, which is a huge time-saver for our staff. Our employees now only have to visit one portal to access this information rather than having to call or fax payers for benefits or log in to multiple payer-specific websites.

Also, the results are standardized, making interpretation of the data quicker and more error-proof. Once we obtain the information we need, we present the patient with a report that summarizes their benefits for physical therapy as well what their out-of-pocket responsibility will be. This gives the patient the opportunity to ask any questions before actually beginning treatment. The last thing we want is a patient to receive a surprise bill after completing treatment.

Q: What are some of the biggest challenges you’ve encountered in your quest to be more price transparent?

A: Often, when patients are given a true picture of their responsibility, they have concerns about the affordability of treatment. We have found most patients do not completely understand their benefit packages and are surprised to learn their insurance does not cover treatment completely. When a patient needs treatment to improve physically, but does not have the means to afford the out-of-pocket expense, they often err on the side of not receiving the required treatment.

Q: How are you addressing these issues?

A: Our goal is to offer as many options as possible. We utilize ZirMed’s Patient Payments to offer auto-draft payment plans to patients. This allows us to estimate the total patient responsibility for their course of treatment and set up payments over time to ease the financial burden. We also offer a medical-credit option to allow patients to finance their out-of-pocket expense. Many of the credit options are deferred interest, and patients will pay no interest if the balance is paid off in the predetermined time frame.

Q: What does it take to provide consumers with accurate pricing estimates up front?

A: We must have a complete understanding of the patient’s benefits as well as knowledge about the type of treatment they may need in order to offer an accurate estimate. Our EMR, TheraOffice from Hands On Technology, assists us in this process by looking at the patient’s previous visits to create an estimate.

Q: What technologies have you leveraged in your effort to aggregate, analyze, and present your pricing data?

A: Our data will only be as good as the effort we put forth in obtaining accurate information. We use information from our payers in the form of reimbursement by visit or CPT code, as well as real-time eligibility information to gather pricing data. TheraOffice allows us to build fee schedules specifically by payer, so as payer contracts change, we can update patient records. TheraOffice also predicts the patient’s responsibility based on previous visits for that patient or patients with the same insurance, and the reimbursement associated with those visits. That information combined with our real-time eligibility information from ZirMed allows us to paint an accurate picture of patient responsibility. In addition, we utilize a national outcomes database, Focus on Therapeutic Outcomes (FOTO), to assist in predicting the length of treatment required for each individual patient. This helps us develop a more comprehensive estimate of patient responsibility over the entire course of treatment.

Q: What processes have you added or altered to become more transparent in your pricing, and how did you communicate these efforts with patients?

A: We have focused heavily on up-front collections. This helps ensure that every patient understands when they begin treatment — as well as at the beginning of each visit — what the patient responsibility will be. In the past, we have experienced angry patients who did not understand that they had a coinsurance requirement for physical therapy or that they had not met their deductible. They were subsequently surprised at the end of their treatment when they received a bill. Our goal is to eliminate as many post-treatment statements for our patients as possible. If we have a patient who has no balance at the end of their treatment, that means we did a great job of communicating and collecting their out-of-pocket expenses along the way. We present our patients with a report that outlines their responsibility at the start of treatment so that they can make an educated decision about their treatment choices.

Q: How do you plan on expanding your price transparency efforts in the future?

A: Our goal is to push the verification function as far forward in the process as possible. We’re beginning preregistration functions that will allow insurance information to be collected prior to scheduling. This will allow us to have the conversation with patients about their insurance coverage and out-of-pocket estimation prior to their first visit so that they can be prepared for the cost of treatment well ahead of time.

Q. How far off do you think true price transparency in healthcare is? Is it even a feasible expectation for healthcare services?

A: I think it depends on the type of service. I can certainly see price transparency being more feasible for the outpatient sector than inpatient services. For physical therapy, which is my specialty, I believe price transparency is a reasonable expectation for patients to have, and we, as providers, have an obligation to supply as much information as possible to our patients to allow them to make an educated decision about where they receive treatment.

This article was originally published here.

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