As the current debate around healthcare reform in the United States intensifies, consumers are making it clear that they want to be involved participants in their healthcare. One key focus of this push has been the demand for transparency in pricing within the healthcare industry. While there have been many strides in answering this call for transparency, the healthcare industry still has work to do to bring consumers in as full participants in their care.
Why Consumers Want Actionable Transparency
One major reason that consumers are calling for pricing transparency is due to much of the hidden and hazy pricing schemes previously implemented across the industry. In years past, consumers would often be told they needed a service, medication or procedure by their medical provider, or perhaps they were referred to a specialist. With price unknown, patients would consent to treatment, only to be unpleasantly surprised by the resulting price of services. What’s more, patients would receive several bills from different providers involved in the care: a radiologist, an anesthesiologist, facility fees and finally from their doctor in question.
As people become more responsible for taking the full financial hit for their medical costs, the ability to view pricing information becomes vitally important. However, many don’t know where to go to find pricing information, even if they want to be made aware. Recent data proves a majority of patients wish to seek price information before a service is provided. This is especially true for people who have a higher cost-share in their care, such as those with high deductibles and out-of-pocket costs.
Compounding the struggle to find pricing information is the ability for people to contextualize the prices they do find. It’s not uncommon for treatment and service prices to vary widely between facilities and providers in the same geographical area. While price is important, additional factors, such as safety rating and special designations, often are used to make a comprehensive decision on whether to choose a provider or facility for their medical care.
By presenting a comprehensive overview of facilities and providers in addition to pricing, fears about price inflation can, therefore, be addressed. Some consumers erroneously believe that higher prices mean higher quality care. This simply isn’t the case, unfortunately. In the absence of standardized reporting on quality and other data such as infection rates and other complications, consumers are left guessing if higher prices listed can guarantee higher quality, or if the higher rates are simply the result of inflation.
Solutions for Consumers
There are several proposed solutions to increase transparency in healthcare pricing. One way to increase state responsibility for facilities and providers is to implement a state-mandated grading system that scores states on their pricing transparency. Some states are taking up the mantle and are making strides to be more transparent with pricing. State-run websites to display median prices for procedures and hospital-wide initiatives to improve communication about pricing are a good first steps in addressing accessibility of pricing.
Recognizing what information truly impacts the consumer decision-making process when it comes to their care is also critical to increase price transparency. While consumers care about the price of their care (especially if the price seems overinflated), they also care about quality standards as well. In the absence of quality information, consumers are often led to believe that higher price equals higher quality. This is a troublesome assumption. For instance, consumers may believe that a higher priced facility will offer a higher level of care, but in reality, that facility may have a higher rate of complications that can be potentially life-threatening to the patient. It’s impossible for the consumer to know either way without consistent reporting of quality issues.
To combat this problem, consumers can use an external company to evaluate the prices and quality of services. Companies like Access Healthnet bundle services into what’s known as episodes of care, so prices are pre-negotiated and fixed. They contract with top-rated facilities and providers for price transparency, so consumers can know their financial responsibility before stepping foot into a doctor’s office.
With Access HealthNet, consumers can find the best value by comparing costs and quality from more than 4,000 provider locations and 100,000 hospital and health system bundles.
Increasing transparency in the healthcare industry will be a long-fought battle. As debates are heating up and changes to rules and regulations become more pervasive, consumers will have to continue to advocate for their place in the discussion about their healthcare needs. By implementing actionable transparency for pricing and regulating quality standards, consumers can be empowered to make the best decision for their ultimate financial and physical health.