12 Tips To Increase Price Transparency For Patients

By Christine Kern, contributing writer

HFMA provides recommendations for patient price transparency in new report.

Healthcare purchasers seeking to improve price transparency for patients would do well to look first at the pricing data that insurance companies have, and uninsured consumers should look to hospitals and other providers for the information.

Those are core recommendations in a recent report from the Healthcare Financial Management Association. HFMA convened a task force that included insurance, provider, employer, consultant, and consumer representatives to identify how patients can receive reliable information on the cost of their care.

The task force agreed all Americans – regardless of their insurance status – should be able to receive accurate price estimates from a reliable source; that transparency should help people make meaningful price comparisons ahead of service; and that price estimates should be accompanied by other relevant information (e.g., quality, safety, or outcomes) that will help consumers assess the value of a healthcare service.

The authors note many insurers already have developed or are building price transparency tools for members. These price transparency tools should contain specific essential elements of information including total estimated price of the service, network status of providers, and information on the benefits structure for out-of-network care, out-of-pocket responsibility, and quality/satisfaction scores if available and applicable. Key recommendations include:

• Health plans should help members estimate their expected out-of-pocket costs, based on their current deductible status along with copayment and coinsurance information. Health plans often have access to price information for many providers in a given region, which they can use to help members factor price into their decision-making process.
• Hospitals should serve as a price information resource for uninsured people. Hospitals should continue to help uninsured patients identify alternatives for sharing their healthcare costs, including other insurance options. Hospitals should proactively communicate to all patients and community members – including the uninsured – that they may be eligible for financial assistance provided directly by the hospital.
• Consumers should receive price information in an easy-to-understand format so they can make the most of the price information resources at their disposal. HFMA has developed Understanding Healthcare Prices: A Consumer Guide, to help consumers get answers to their questions about healthcare prices.
• Employers can play a role in price transparency by encouraging their employees to be engaged in their healthcare decisions.

Other recommendations include:

• Price estimates should explain the services included and the difference in network status on such estimates.
• Providers should understand that a number of state and federal laws dictate price transparency for the uninsured.
• Medicare and Medicaid plans should develop better price transparency tools for beneficiaries. CMS should add user-friendly price transparency functions to the Hospital Compare website, “similar to those that are being developed by health plans, to assist traditional Medicare beneficiaries in better understanding their out-of-pocket responsibilities and to assist them in locating high-value providers,” according to the report. “Although information on Medicare-approved payments is publicly available, the task force notes that this information in its current format can be difficult for Medicare beneficiaries to locate and understand.”
• Report authors also call for public, state-supported websites offering information on the price and quality of care of providers within a state. These sites should emphasize to the extent possible with available data the average amount paid for services instead of the average amount charged.

The 24-page HFMA report with its dozen recommendations is available here.