Healthcare purchasers seeking to improve price transparency for patients would do well to look first at the pricing data that insurance companies have, and uninsured consumers should look to hospitals and other providers for the information.

Those are core recommendations in a recent report from the Healthcare Financial Management Association. HFMA convened a task force that included insurance, provider, employer, consultant and consumer representatives to identify how patients can receive reliable information on the cost of their care.

Many insurers have developed or are building web-based or telephone price transparency tools for members, report authors note. “These tools have the potential to benefit both patients and health plans, providing patients with needed information while strengthening the health plan’s value to members. Employers with self-funded plans have the option of working with health plans (which often serve as third-party administrators for self-funded plans) or other vendors in developing transparency tools for insured employees and their dependents.”

Price transparency tools should contain specific essential elements of information, according to the report. These include total estimated price of the service, network status of providers and information on the benefits structure for out-of-network care, out-of-pocket responsibility, and quality/satisfaction scores if available and applicable.

Other recommendations include:

* Price estimates should explain the services included and the difference in network status on such estimates. An imaging service estimate should include the facility costs for taking the images and the radiologist’s fee for reading the images. Patients receiving in-network care should be informed if the radiologist or other specialist they are being referred to are out-of-network.

* Providers should understand that a number of state and federal laws dictate price transparency for the uninsured. “As consumer price sensitivity has intensified, so too has media attention to healthcare prices. Providers that can speak accurately and confidently about their prices will be better positioned to succeed in this environment than providers that can only refer back to their charge schedule.”

* Medicare and Medicaid plans should develop better price transparency tools for beneficiaries. CMS should add user-friendly price transparency functions to the Hospital Compare website, “similar to those that are being developed by health plans, to assist traditional Medicare beneficiaries in better understanding their out-of-pocket responsibilities and to assist them in locating high-value providers,” according to the report. “Although information on Medicare-approved payments is publicly available, the task force notes that this information in its current format can be difficult for Medicare beneficiaries to locate and understand.”

* Report authors also call for public, state-supported websites offering information on the price and quality of care of providers within a state. These sites should emphasize to the extent possible with available data the average amount paid for services instead of the average amount charged.

The 24-page HFMA report with its dozen recommendations is available here.

Register or login for access to this item and much more

All Health Data Management content is archived after seven days.

Community members receive:
  • All recent and archived articles
  • Conference offers and updates
  • A full menu of enewsletter options
  • Web seminars, white papers, ebooks

Don't have an account? Register for Free Unlimited Access