Big Idea 2013: Healthcare Price Transparency
Mary Pat Whaley, FACMPE, CPC
Medical Practice Consultant, Manage My Practice LLC
Private practices, hospital-owned practices and affiliated group practices are facing big changes from healthcare reform, demographic shifts, and economic and reimbursement pressure.
The industry is re-evaluating itself from top to bottom and looking for new business models, ideas and opportunities to make medical practice feasible. Health insurance is changing as employers and payers are reducing benefits and shifting costs to patients. High deductible health plans (HDHPs) are becoming more popular, and with that patients are thinking more like customers, and making their healthcare decisions based on out-of-pocket costs. Patients want access to pricing info, and are not satisfied with "it's complicated" as an answer. The industry as a whole is moving towards rewarding performance over volume, and patients will also be armed with more publicly available performance and safety data.
In short, bedside manner and reputation are not enough anymore: practices now have to compete on price and quality in a more explicit way than ever before. We are advising our medical practice clients to take a long hard look at how they set their prices. Setting your prices does not have to be a complicated exercise when you have a basic understanding of your overhead. If you understand what it costs to produce each RVU of service to your patients, than you can understand what a self-pay or high-deductible patient needs to pay in costs and margin. Then tell your customers what your services cost. This is what other businesses do.
Price transparency improves patient satisfaction and trust because patients can relate what they are paying for to the value they are getting. It eases conversations about patient financial responsibility. Patients want to understand the money behind the treatment they are getting, because they have more financial "skin in the game" than ever before. Engage your patients in this process immediately by publishing your fees!
Mary Pat Whaley is a practice management consultant who blogs at Manage My Practice.
CEO & Co-Founder | Board Member | Executive of the Year in Oregon | Ex - BCBS, LEGO, XEROX, ZoomCare | Growth | Advisor to Startups | Digital | Healthcare | Consumer Experience
11yGreat article on price transparency which is one important element to achieve a better patient experience in this complex system. At HealthSparq, we believe in price transparency and have added two additional elements: quality and user-generated content such as reviews and discussions. Lots of innovation happening right now all to the benefit of patients and consumers in general. A consumer-based and data-rich experience (like we know it from so many other industries 'personified' by TripAdvisor, Netflix and Amazon) is finally evolving. . . .
Managing Principal Exp Technology Consultants -- Zero-Knowledge Tech, Expert Witness, Web3, Generative AI
12yGiven that healthcare choices (at least the expensive ones) are always emotional (very strong survival instinct) and not based on an economical decision process, enhanced price transparency is nice and would be helpful but does not address the fundamental issues: a) providing healthcare is treated as a business with the expectation of making profit i.e. making money off of other people's physical problems b) on average, 80-90% of a persons lifetime healthcare costs are generated during the last 3 months of life c) over-regulation creating a huge overhead and d) too many people (as an overall percentage of the workforce) are directly economically dependent on the health care sector creating too many losers if health care costs were actually reduced. a) - d) means only an external shock e.g. revolution or threat thereof, war, natural disaster will lead to a true change i.e. lead to an alignment of interests of all stakeholders. Sad but true. Please, remember that social security and health insurance was invented by Otto v. Bismarck in the 19th. century only under an acute revolutionary threat to the prevalent political system. He was not a humanitarian - he wanted to prevent the social democrats and communists from overthrowing the monarchy.
Healthcare IT, Project Management, Leadership, Professional
12yInteresting perspectives from providers, consultants, and actuary... Should a Price / Care Quality Best Practice Model be in the works that's sustainable?
We need transparency in government. When the PPACA was being considered. it was kept a secret what the law would be. Now that there is not the ability to repeal it, the regulations required to implement it are 30,000 pages and growing.
Practitioner, Integrated medicine; and, Research in Unconventional Medicine, Spirituality, Philosophy, Metaphysics and
12yWhen Healthcare system is considered as a pure business, healthcare cost transparency is to be considered as a must. But, I perceive that Human health care is something like agreement between the Doctor and his patients, where one can not expect fixed rules. It is because; a poor patient can not be ignored,if the patient surrender himself to a doctor. Moreover, must adjust such situation by compromising his price policy. I have been adopting such policy since last more than three decades. My consultation and examination fee is next to nil for the poor patients and it is higher for the rich. Thus,there should not be any hard and fast rule regarding doctor's fees (what is called transparency) in the human health practice,especially in the developing and underdeveloped countries.