Hospitals have overwhelmingly complied with the Centers for Medicare and Medicaid Services’ requirement to post chargemaster prices online by Jan. 1, 2019. But predictably, the move was of little immediate help to patients—even to hospital pricing experts—who want to understand their financial responsibilities for procedures they may be about to undergo.
Hospital communicators have long understood that a chargemaster isn’t really designed to help patients understand what they might pay for the birth of a child, a knee replacement or an MRI. Building a Rube Goldberg machine might be simpler than using a chargemaster to figure out what you’ll pay.
It’s a difficult tightrope to walk: comply with the reg, but avoid becoming a scapegoat for the consumer-unfriendly face of healthcare. To avoid this predicament, hospitals can take a few steps beyond the requirement to help patients—and media—navigate the morass. But what’s the best way to handle the increasing desire for a more consumer-friendly approach?
Here are four helpful lessons learned in the first 60 days of “price transparency.”
1. Don’t just meet the letter of the law.
The CMS requirement doesn’t require Flash or animation, nor does it require ‘prominent placement’ on the hospital’s website as some other regs do. But compliance with it does invite criticism if you’re just (barely) meeting the reg’s requirement.
Your chargemaster can be loaded a few layers down in a “Resources” or “Patient Info” tab, but you should make sure that it’s not the only resource for patient pricing on your website or even the only resource on the page where it’s posted.
As a service to patients, consider posting the chargemaster link near where you post financial assistance information or self-pay policies. You can even place a helpful suggestion to patients to contact the hospital to get a more personalized cost estimate, if your facility, like many hospitals, is equipped to provide such a service. Be sure to point reporters in that direction also. CMS Administrator Seema Verma herself has commended the Mayo Clinic and others for providing resources for patients that exceed the requirement.
2. Consider being proactive.
Making proactive outreach to local media to tout your organization’s helpful pricing tools or personnel, if you have those resources in place, can be an effective strategy to set your hospital apart.
Educate media and the public that all patients are encouraged to be active in the management of their own health and are expected (by employers and insurers) to share more of the direct cost for care these days.
3. Be prepared to respond – and educate.
Much of the initial complaining about the uselessness of hospitals’ wickedly complex lists of procedures, facility and physician charges has come via reporters. You may have fielded calls from the media already if you haven’t taken some of the proactive steps above.
Like patients – and 99.9% of the population – reporters don’t fully understand why health care pricing is so complex. Many hospitals put time into developing straightforward, plain language summaries to help patients and reporters understand the organization’s financial policies. Insurance coverage, charity care policies and self- or prompt-pay discounts ensure that patients almost never pay chargemaster prices (or anything close). They are a starting point for negotiations – mostly with large insurance companies and managed care organizations.
Case examples (even infographics) of Joe Public’s knee surgery or Christie Consumer’s appendectomy can help illustrate how insurance and discounts reduce patient costs (without violating HIPAA).
4. Make longer-term plans to provide accurate, personalized estimates.
Although many hospitals don’t have sophisticated capabilities to provide accurate estimates, this is becoming a business imperative as more patients bear greater financial responsibility. Amazon started spoiling us with quick cost quotes 25 years ago – and countless industries have been forced to follow their lead.
Smart hospitals are making long-term investments in transparency tools for their websites and an FTE or two within the financial department – experts who can take some of the mystery out of the often-stressful experience of receiving and paying for health care services. There is a business case, and ROI, for doing so, especially as patients become more responsible for paying for their own health care.
Though media interest in hospital chargemasters may have slowed for a moment, don’t expect that lull to last. With the CMS requirement that hospitals provide their chargemaster in “machine readable format,” you can bet that innovators in the private sector are already working on programs that will incorporate your charges information into an easy-to-use app.
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