Blogger Spotlight: Price Transparency and Consumer-Driven Healthcare

With all the talk about consumer-driven healthcare plans, high-deductible plans and the need for price transparency in the health care industry, we wanted to highlight some of the less well-known bloggers that are contributing valuable information to price shoppers and their tools for educating the price sensitive patient population.  The following blog sites contribute helpful tips to patients looking for ways to save on medical expenses and become more active advocates for their own care.

1. Employee Benefit Research Institute

"While the link between health insurance coverage and employment has long been known, these data underscore the degree to which unemployment rates directly affect the levels of the uninsured in the United States,” said Paul Fronstin, director of EBRI’s Health Research and Education Program and author of the report. “

Read more posts like: Employment-based Health Coverage Rates Continue to Fall

2. US Bank: Healthcare Payment Insider

" One of the mistakes we often make in our benefits communications to employees is focusing on their addedresponsibility, rather than on the positives of that larger burden. You can’t make a case that it’s great to pay more money out of pocket. Instead, you can highlight what “having control” really means: greater understanding (resulting in less stress), greater savings (from lower-cost premiums and fewer non-essential tests and medications), and a greater say in their own care. That’s empowering. And that’s the advantage of consumer driven healthcare.”

Read more posts like: Let’s Call It What It Is: A Low-Premium Health Plan

3. HSA Guy- Scott Borden

"There are several exciting things about Consumer Driven Health Care plans that are proving to reduce costs. One of the best things is pricing transparency."

Read more posts like: More Employers Steer Towards Consumer-Driven Health Plans

4. Universal Specatator: Health Care

"A select portion of the population chooses to carry the risk of medical expenses themselves rather than buying into an insurance plan. This group tends to be younger and healthier than insured patients and, as such, accesses medical care much less frequently. Because this group has to pay for all incurred costs, they also tend to be much more discriminating in how they access the system. The result is that patients (now more appropriately termed "consumers") comparison shop for tests and elective procedures and wait longer before seeking medical attention. The payment method for this group is simple: the doctors and hospitals charge set fees for their services and the patient pays that amount directly to the doctor/hospital."

Read more posts like: Who’s Paying fro Health Care- Understanding the Payors

5. Statistic Brain

uninsured statisticsStatistic Brain- Uninsured health statisitcs Source: U.S. Census Bureau 1/25/12

6. American Affairs Suite 101

"Another 10.1 million of the 46 million “uninsured” have incomes of more than more than 3X the poverty level. For a family of four, if the household income was more than 3X the poverty level in 2007, they had $62,000 of income or more, and well were above the national median. An additional 9.3 million are non-citizens. Of the remaining 15.6 million uninsured, 5 million are between ages 18 and 34 and without kids. This leaves 10.6 million people in the United States who have no health insurance and do not fit in any of the above categories."

Read more posts like: A Look Inside the Uninsured Numbers

7. E-News Site

“But what about the 43 million Americans who are uninsured and thousands more who are inadequately insured?”This was duly considered and discussed and then another member stated; “You are speaking to one, I only have major medical with a high deductable.”

Read more posts like: 43 Million Americans Do Not Have Health Insurance or are Inadequately Insured

8. The Dish: Biased and Balanced

"Price transparency seems like the kind of thing that everyone should be able to rally around. But you’d be wrong. Pretty much everyone in the health-care world—other than the patient—has an interest in keeping prices opaque."

Read more posts like: Why Is Healthcare Price Transparency So Hard?

9. Save On Medical Blog

"This is why 32% of patients are price shopping for their care.  Patients are learning that by being well-educated about their care opportunities, they can acquire quality care at affordable prices. Since radiology services are the procedures most frequently searched for, be sure to investigate before spending or deciding to go without care.”

Read More Posts like: Patients Find Affordable Health Care

10. TRENDSparency

"Consumers themselves must be aware that you can shop for care as you would any other consumer product. In short, people think they have little responsibility for the cost of their healthcare, when the reality is quite the opposite.Forbes writer Zina Moukheiber echoed those sentiments about our HCTI, calling it “More Proof to Shop Around for Care.””

Read more posts like: Preventative Care Under the ACA: Transparency Offers Opportunities for Healthcare Consumer Empowerment

11. Zina Moukheiber’s Healthworks: Forbes Contributor

"As consumers start bearing the brunt of costs, they are going to shop around and push for greater price transparency."

Read More Posts Like: Start-Ups Can Help You Reduce Health Care Costs

12. Taegan Goddard’s WonkWire

“Most doctors and hospitals would rather not post their prices, because then patients would shop around, placing pressure on their incomes. Insurers don’t like price transparency, because they view the rates they negotiate with hospitals and doctors as proprietary trade secrets that give them an advantage over their competitors. Suppliers of medical products, of course, also benefit from high prices… Transparency is the sort of thing that Republicans and Democrats should be able to agree on. But instead, they’ve agreed to let industry lobbyists preserve the status quo.”

Read more posts like: Who Opposes Health Care Price Transparency?

13. FierceHealth

"As healthcare costs continue to rise and fluctuate based on hospitals’ location, price transparency efforts will continue to be important."

Read more posts like: Online Healthcare Price Transparency Tools

RBMA Marketing Lessons

Didn’t make it to any RBMA Marketing forums yet this year? That’s okay, we’ve got the inside scoop. It seems most conversations revolved around industry changes, what’s next, how to use strategic planning and how to gain market leadership.

The glory days of easy-come health care are behind us, take a look at the changes that have occurred over the past decade:

-       more aggressive competition efforts

-       hospitals gaining market dominance by purchasing practices

-       reimbursement cuts causing dips in profitability

-       trends towards low cost providers

-       increased expenses to remain competitive

-       rapidly evolving technology advancements

-       patients opting out of insurance benefits due to high deductible health plans

Thinking about trends in healthcare and examining the changes that have taken place will help you to prepare and protect your practice in the next phases. Here are some things to consider about your practice in strategic planning:

-       understand your state in the market

-       be realistic about strengths and weaknesses

-       identify opportunities for growth in market trends

-       define realistic goals

-       examine commodity vs. quality

We have completed an extensive market analysis of the radiology industry as a whole, examining expected trends and what that means for your practice, in addition to the steps necessary to gaining market leadership in your area.

A Cartoonist's View of Health Insurance

Dear Supreme Court,

Health Insurance Sucks.

Sincerely,

Jen Sorensen

Since it’s Friday, Kaiser Health News was feeling silly and shared this great masterpiece from the mind of cartoonist Jen Sorensen, on the trials and tribulations related to high health costs and the challenges associated with health insurance. It seems like there should be an easier way to find affordable healthcare in the United States… right? In the words of Dane Cook, “it’s funny, because it’s true.”

jen sorensen save on medical resized 600

If you liked this strip, be sure to check out more of Jen Sorensen’s work at Slowpoke Comics.

True Trends in Health Care Markets

I recently read an article entitled How to Build the Radiology Department of the Future which discussed ways tomaintain profits and growth in an evolving health care market.  It highlighted the most efficient and profitable ways to find growth and prepare your practice for the future, however it was written from the perspective of an obvious hospital-system based supporter, geared towards the independent radiologist sector, where common ground is hard to come by.

The author comments on several market trends, such as; the employment of radiologists by hospitals, the importance of quality, hospital partnerships, hospital imaging departments as epicenters of care, falling reimbursement and requests for hospital subsidies for the radiology department.  These “trends” seem to directly play on the fearful emotions of independent radiologists and they need to be aware of the true trends and their options.

True Trends:

-       over 50 million uninsured Americans leading to self-pay patient population

-       32% of patients price-shop and hospital-based practices do not have the most affordable options

-       there is little to no price transparency at hospitals and looking for pricing is near to impossible without the appropriate resources

-       there is now a call for transparency and it is coming directly from patients

-       reimbursement is down for everyone, physicians must look to untapped patient populations

-       consumers are ingrained to think that quality is reflective of cost, patients are becoming smarter than this

(watch the video below expressing the variances of pricing in cities throughout the country, the interviewed patients express the need for transparency and they’re not the only ones!)

 

Resorting to teleradiology and impersonalized care is not the answer to decreased revenue and patient volume. Creative marketing efforts, physician integration, seamless billing and collections practices and a self-pay processing plan are the components necessary to overcoming the true trends in the health care industry as it exists now and in the future.

The 5 Myths of Self-Pay

Whether you’re a patient or a health care provider, it is likely that you have heard the myths about the self-pay process.  In the past, health care providers have referred to self-pay patients as “no-payers” due to the stigma associated with them that their fees go uncollected.  Trends towards transparency in the health care system, the rise in uninsured patients and resources springing up to serve as reference points for quality, affordable care have started to clear up the myths that exist.

After speaking with a number of physicians and patients across the country, we have assimilated this list of myths, and will address each falsehood:

  1. The only way to get quality care is through an insurance plan and services are too expensive without insurance.
  2. Providers cannot charge less than Medicare for services.
  3. Third-Party Payers will renegotiate contracts depending on a practice’s discounted cash-pay prices.
  4. There is no efficient way to collect self-pay payments.
  5. People without insurance are ill educated when it comes to health care pricing and quality.

1. The only way to get quality care is through an insurance plan and services are too expensive without insurance.

As long as patients know where to look, they can find highly reputable providers with affordable pricing options.  Uninsured patients can also negotiate pricing in many instances.  Keep in mind that high quality care does not necessarily translate to lack of affordability.  There is very little correlation when it comes to quality and pricing in the health care system; just because a location charges $1400 for an MRI, does not mean it is better than the facility charging $450.

2. Providers cannot charge less than Medicare for services.

There is no existing prohibition for offering a discount to uninsured or underinsured self-pay patients.  The CMS (Center for Medicare Services) has stated that discounts, when based on financial situations, are not considered kickbacks, and thus they do not violate any existing laws or regulations.

3. Third-Party Payers will renegotiate contracts depending on a practice’s discounted cash-pay prices.

Providers are expected to have “reasonable and customary” charges, which are established based on the cost of providing the service.  That amount is what is billed to all payers, including self-pay patients.  In most cases, insurance providers contract with medical offices a discount off of the charges. Often times however, the self-pay prices are simply a reflection of a practice’s Medicare Fee Schedule.  As with Medicare, providers can offer discounts based on financial situations. This should not alter the reasonable and customary charge based on costs, or the amount a payer is willing to pay by contract.

4. There is no efficient way to collect self-pay payments.

In the past, physicians rarely saw full collections on self-pay payments because of ineffective processes.  Practices spent an extraordinary amount of time and money chasing down lost payments, looking backwards instead of forwards.  Self-pay collections will improve with transparency and by collecting the payment before or at the time the procedure is performed.

5. People without insurance are ill educated when it comes to health care pricing and quality.

Gone are the days when being uninsured meant you were unprepared, unemployed or uneducated.  Employers adopting consumer-based health plans and high-deductible health plans have led Americans to realize that acquiring care on a cash-pay basis and price shopping is oftentimes more economical for their families.  This being said, 32% of patients are actively price shopping for care. We have learned that in most cases, these uninsured patients are typically the most knowledgeable of pricing, quality and the health care system as a whole.