The Technology is Able; Now, the Moral Imperative to Simplify Billing

Earlier this month, a panel I moderated discussed business process innovation from mobile medical banking. Panelists identified a long list of challenges that stand in the way of helping patients in the U.S. in doing the difficult – compare providers’ prices, find out how much they owe and to whom, and pay their bills.

The dream, of course, is to make it as easy for customers to pay their healthcare bills as it is to pay any other bill they get nowadays. Alas, it’s only a reverie at this point, not a reality.

The panel discussion was part of the 39th World Hospital Congress conducted by the International Hospital Federation in Chicago.  After the panel cited the litany of problems, the director of the conference and executive director of the IHF, Eric de Roodenbeke, was asked to make some comments in reaction.

While de Roodenbeke termed the discussion very interesting, he said, smiling, “This is not a problem we have in France.” There, under a single-payer system, there’s more standardization, and fewer problems, less administrative hassle and more success.

That did little for my morale. Providers wanting to improve service to customers are struggling. Vendors trying to offer service to consolidate provider prices into one bill or facilitate payments are frustrated by customized ANSI transaction standards and much, much more.

Without transparent pricing, consumers never know what they’re paying for healthcare. Without explainable prices and absent the ability to get bills to patients quickly, providers are less likely to get paid in a timely manner. That’s a killer when providers are seeing margins shrink. While providers are doing a better job of informing patients of their obligation upfront, they struggle to receive payments any faster than they did five years ago.

In a world where consumers can buy things with one click on any Internet site, consumers are left holding the responsibility to manage the confusing world of medical bills coming from multiple providers (some of which they may not even be aware of).

One of the panelists shared this advice for patients, provided by a major hospital system on its website:

“You may receive separate bills for hospital and physician services. Sometimes it comes as a surprise after paying the hospital bill to receive additional invoices. We know that keeping track of multiple bills in the midst of an illness is an added challenge. Before your stay or procedure, it may help to create a master list with the estimated costs for your medical treatment, breaking down the costs by category such as hospital, surgeon, anesthesiologist, outside lab work and other relevant areas. Then as the invoices come in, keep copies in a folder and refer to your master list to see which bills are outstanding and quickly check for remaining financial obligations. Don’t be shy: Ask your primary care physician’s office or our customer service department for help understanding all the expected charges and their sources.”

That, in microcosm, describes the challenge before healthcare – this confusing world of pricing and billing should not fall back on the patient to create master lists to avoid being surprised about all types of bills coming from everywhere. Information systems need to get better; standardized transactions need to be truly standardized to enable interoperability; billing needs to be streamlined, understandable and crystal clear, with no patient left guessing about prices.

As the patient advice above was being read, I imagined my 91-year-old mother trying to use that approach to manage her healthcare costs—or me trying to help her. For the good of its patients, for the good of patients’ families, for the survival of healthcare organizations, it’s a moral imperative for healthcare to simplify pricing and billing. Without simplification, providers shouldn’t be surprised that cash flow consequences will result.