Price Transparency: Become a Positive Deviant Part III

Let's continue the conversation on effecting positive change by communicating pricing/quality data to patients, staff, and community stakeholders.

For transparency to work, both docs and patients must buy in to an evolving view of efficient modern health care as a process and partnership that requires the active and engaged participation of both parties

And yes, patients, I mean you - how many of us can't even recite the names/doses of current prescription medications or dates/diagnoses related to care in the past five years?

Without this view, hospitals releasing numbers will just be spinning the wheels.

ranted, the rest of us will have some nifty high-deductible-based pricing tools to play around with in the meantime.

And hospital executives, although patients may be telling you they want info on prices, don't discount the fact that "all this readily gleaned customer feedback can lead you astray (from Freeman, Inc. Magazine July 07 "Ask and You Shall Be Misled" - link below).

Don't let demands for pricing outpace a well-designed strategy for releasing cost/quality data. Freeman makes a great point that if you're not used to soliciting feedback from customers, you may overreact when faced with a mountain of complaints about pricing and quality info.

Some of these complaints may arise from simple misunderstandings - successful transparency campaigns also requires rising levels of patient literacy...without improved patient education programs we'll just be spouting data many customers aren't equipped to incorporate into individual treatment goals.

There's a great article by David H. Freeman in the July 2007 issue of Inc. Magazine (page 63 of the print edition) titled "Ask and You Shall Be Misled: Customers can tell you a lot. But sometimes they don't know what they're talking about." Hospital/healthcare CEOs should read it, especially given recent industry flack about listening to customers and incorporating consumer feedback.

Transparency is important yes, but perhaps not the vital primary issue in healthcare. So how does transparency play in to the current single-payor/UHC debate?

Universal health care is a different animal entirely than universal health coverage.

The former will require multilevel participation from patients and caregivers, while the latter will make sure that everyone's &(%$#@ and esophogi are covered.

I'm going to go out on a limb and argue putting health care under either 'universal' umbrella doesn't matter if patients still don't have access to care based on information about provider pricing and quality.

Take a breather, because we're just getting started.

If and when you get patients to buy in to the idea that price/quality data is important, you have to explain the small print.
Using a generalized price transparency tool like that at the WVa website is a bit like signing up for a mobile phone coverage plan.

You agree to plunk down 59.99 a month for service, but when you get your final bill there are ALMOST ALWAYS additional hidden or unanticipated charges related to usage variations.

With any medical procedure, costs will vary, sometimes significantly, based on the patient and her particular set of circumstances (including complications).

In addition, early iterations of pricing estimators available to consumers may not take into account all 'true' costs related to the procedure - and related recovery process, which can add significantly to costs incurred.

With a TKR for instance, does the fee listed include surgical workups, preop anesthesia assessments, labs, and extra costs incurred during the hospital stay such as parking, prescription copays, etc.?

What about ambulance transport home if needed, a quad cane, a shower chair or other equipment indicated by a PT, RT, OT, ST, or social worker/case manager prior to discharge?

And what if something goes awry in the OR and an additional surgeon is called in, increasing the cost of the procedure? What if the patient develops a condition during surgery that requires additional follow-up care? Or becomes infected with a nasty bug circling the halls?

Currently, sites don't include pricing tools for ancillary services or programs related to follow up care.

Take physical therapy after TKR for example, which can add quite a hefty chunk to total costs related to the procedure. Competitive pricing information, hours of operation for the hospitals rehab medicine department, etc. would allow a patient to make a more informed choice when selecting related care providers.

The issue is a toughie. But there are basic structural must-dos to get the process started.

  • Hospitals - provide pricing info for your docs. Use examples already at work "in the field" such as CompareCareWV.
  • Patients - request hospitals and docs make price information easily accessible in house and on the web. Acknowledge that you will need to follow up with your insurance provider to confirm coverage/approximate costs.
  • And med schools/residency programs, for goodness sake - start training your docs on how to handle pricing requests and, better yet, increased levels of patient engagement/involvement. Docs, Nurse Practitioners, Nurses, and Physicians' Assistants will be the frontline advocates for increasing levels of patient health literacy.

Transparency is a team effort, and there's no I in team.


Emma said...

Very interesting, I am wondering where is their pricing information coming from? Looks like it comes from some sort of government database (which makes me nervous by default). Also, I think that pricing information alone (without quality) is dangerous. Most people will automatically assume that higher price means better quality (which is of course not always the case).

Paul Levy said...

Sorry, what does price data mean? Is it the price an insurance company pays my hospital? In that case, it varies by company. And, by the way, I am not permitted to disclose it.