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How Medical Practices Can Get Ready for Healthcare Pricing Transparency

Driven by consumerism and the ongoing desire to lower healthcare costs, healthcare pricing transparency is upon us. In fact, as of January 1, 2019 in-patient and long-term care facilities are now required to publish a listing of their standard charges online and update that listing on an annual basis. As a healthcare provider, you may ask yourself how can you best prepare for what lies ahead. Here are a few suggestions to not only help you navigate this bumpy road but also use it to your advantage.

As with most other goods and services we buy, the cost of healthcare should be made known to patients prior to treatment. CMS’s new rule is meant to help patients understand what their financial liability might be for hospital in-patient services so that they can decide when and with whom they receive care based on how much that care will cost. This also helps to minimize sticker-shock after the fact so that there are limited “surprises”.  While medical practices are not required to comply with the new hospital rule, healthcare price transparency could help practices compete with local hospitals on this front. 

Man using stethescope on coins for healthcare costsAs a practice, use price transparency to your advantage

While this rule begins to provide patients with some of the pricing transparency they look for, it’s only a starting point. Standard costs and chargemaster prices do not account for contractual discounts by payer. Health insurance and patient cost sharing have many moving parts: different health plans, deductibles, co-insurance, provider networks, contracts, and carveouts. Some provider and insurer agreements may even prevent insurers from posting provider fees on their online price look-up tools for plan members. All of this makes it difficult for patients to get a true handle on out-of-pocket costs.

Today in some States such as Washington and New York, there are online tools that provide pricing based on actual claims data. Claims data is a more accurate reflection of cost as it’s based on claims that have been paid. also provides beneficiaries a tool to compare Medicare payments and copays for procedures that are performed in both hospital outpatient facilities and ambulatory surgical centers. The tool displays national averages for the amount Medicare pays to the facility and the copay a beneficiary with no Medicare supplemental insurance would pay to the provider.

For certain services, practices compete with hospitals who invest in outpatient facilities. However, practices can deliver those services at a much lower cost. Use this to your advantage and, if available, add a link from your practice website to your State’s pricing tool. On a State cost compare website, input a procedure you wish to compare along with your zip code(s) to generate a link to that query. Then, on your website, simply add a button titled “compare costs” linked to that query. 

Discuss affordable care options and plan for medical expenses

Don’t be afraid to discuss affordable care options with patients. Consult with patients on the various options available today to finance their care. These may include a payment plan directly with the practice, using a financing lender such as CareCredit, a credit card, or medical flexible spending account. Send a financial letter to patients detailing and confirming their insurance benefits and coverage so that patients understand what their expected out-of-pocket costs will be beforehand.

Add an online patient cost estimate form to your website

Add a secure patient cost estimate tool to your website similar to the example at IU Health. This would allow patients to securely request a cost estimate right from your website. Once received, you can use the information provided to generate a personalized estimate based on the patient’s insurance and site of service for that procedure. Using a form builder tool such as Practis Forms, you can also add a HIPAA-compliant price estimate form to your site.

Post your standard charges on your website

As a medical or dental practice, use cost transparency to your advantage. Providing your standard pricing to patients allows them to better understand and prepare for the cost of their care. In addition, practices compete with outpatient facilities for certain services. However, practices can typically deliver those services at a much lower cost. Why not promote that. Add an online cost calculator to your website similar to this example

Empowering patients to understand the costs of their care will continue to be an important initiative.

It’s good to remember that price transparency itself is not an end goal but rather a journey towards helping patients make care more affordable. Implementing processes and solutions within your practice that will support this journey will allow you to stand out and compete in your market.

Have an interesting approach you’d like to share? Please reach out to someone here at Practis and let us know how you are navigating the road to price transparency.