Case Study- Online Price Estimator, Leveraging Hospitals Serve Patient Needs!

 Erika Regulsky Tags: , , Medical Billing, RCM
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Many Hospitals are working towards providing a cost estimator tool for their patients, in order to know the price estimates for medical services.

Camino Hospital in California, a not-for-profit organization, launched a consumer self-service tool in May 2017. The hospital partnered with Experian Health to develop the tool, and after a year of effort, the tool is sitting on their website. Earlier, the same company had set up an internal price-estimator tool for its billing staff.

After the tool was launched on their hospital’s website, more than 3000 people have visited the website, selecting 90 medical or surgical services. Once the insurance information is entered into the tool, an instant out-of-pocket cost estimate pops out, according to hospital sources, the cost estimate is 95% to 99% accurate.

Experian & Recondo, two leading vendors

Experian and Recondo are the two leading vendors working with a growing number of hospitals offering online price estimates directly to consumers for not-so-complex services. Patients in the past received estimates from hospital staff when they called or visited the hospital for service.

The growing popularity of the tool has caught the imagination of many providers, who have started offering similar self-service cost estimators on their websites. Patients in high-deductible health plans want to look around to determine their financial participation in advance. 

In a way, it benefits the collection process of the hospital because it lowers the volume of uncompensated care. Patients too get a firm grip on the cost to know and understand how much it would cost them.

Patients Have No Time to Make Phone Calls

Teri Manifesto, El Camino’s senior director of revenue cycle manaagement speaking to Modern Healthcare says “A lot of people don’t have time to make phone calls or wait for a callback” further stating “They want an answer right away; they expect this kind of information online. It’s a great thing to offer patients”.

Currently, the hospital offers estimates for 35 lab tests, 25 imaging or radiological procedures and about 30 surgical or other medical services, and for providing this service, the hospital spends about$18,000.

Increasing public anger about unexpected large bills has had many providers experience mounting pressure from regulators and consumers to be transparent about costs. In a recently proposed rule, CMS requires hospitals to publish online a list of their standard charges in a machine-readable format and wants the information updated at least once a year.

Cost Estimator Has Limitations on the Types of Services

There is a perception that although consumers have the convenience to know the cost, there are limitations to the types of services for which consumers are able to price shop. There is an element of risk, according to experts, of consumers getting confused about complex services, and in the bargain start blaming providers for underestimating the final cost. Efforts by vendors to improve the reliability of the estimates continue, particularly for surgical procedures involving more cost variables.

In the current scenario, hospital leaders believe that insurers are better placed to advise patients the cost they owe for specific services, citing the absence of any infrastructure giving providers access to the necessary information. 

That belief, however, is losing acceptability, as health organizations realize the utility value of the tool since more and more patients want to know the cost before they move forward. This has made hospitals look for vendor/partners to help patients know out-of-pocket cost-estimates. 

Suzanne Delbanco, executive director of Catalyst for Payment Reform, which monitors healthcare transparency, feels there are quite a few examples to suggest that if providers want to offer better information to consumers, they can build the capacity to do it. Speaking to Modern Healthcare she stated “It clearly can be done, and symbolically it’s the right thing for providers to do”

Vendors Partnering with Hospitals

This has opened up new avenues for vendors to fulfill the needs of hospitals and healthcare providers for online patient price-estimator tools. John Yount, vice president of healthcare solutions at TransUnion, expressing his opinion to Modern Healthcare, stated: “This is an absolute area of interest based on regulation, high-deductible plans and increased patient responsibility for bills”. The healthcare solution provider is working towards launching a patient self-service tool on the market by the end of this year.

The first price-estimator tool for hospitals internal use in 2008 was offered by Experian, the Franklin-based company in Tennessee. Some of the leading hospitals and healthcare providers, physician groups, outpatient departments, and imaging centers have been their customers. 

They currently support 10 customers, who’ve deployed the online tool, with St. Clair Hospital in Pittsburg being the first to offer it to its patients in 2016 after it was tested by Experian. 

Tool Provides an Out-of-Pocket Cost

The tool calculates the out-of-pocket cost referencing the chargemaster price. Citing history as its source of information, the contract terms with the patient’s insurer, the benefit structure and deductible status are all taken into account before the patient knows the approximate cost. It also provides self-pay patients an out-of-pocket cost, although currently the estimate only includes the facility fee, soon professional fees will also be included within the tool.

The providers also have a choice of presenting the patient an out-of-pocket-cost only, in addition to having the option of including facility fees, or professional fees only.  They can also divulge their actual charges and insurance payment rates. 

The competitive arena of the healthcare industry, according to vendors, prevents many providers from divulging a full spectrum of cost, other than their out-of-pocket responsibility. The avoidance is to conceal proprietary rate information from rivals.

Offering the Tool is a Marketing Advantage for Hospitals

Merideth Wilson, a senior vice president at Experian, speaking to Modern Healthcare commented, “Offering an online price estimator is a marketing advantage for hospitals and medical groups that want to be transparent with patients,”. He feels satisfying the needs of customers helps brings more patients back. Health organizations pay Experian a one-time implementation fee and a monthly maintenance fee based on patient visit volume.

Many vendors are vying for a market space for promoting their online cost estimator. Recondo, the Denver based company released their online tool named ‘MySurePayHealth’ three years ago. They currently support a dozen hospital systems, including Baylor Scott & White Health and ProMedica. 

The Vice President of the company Heather Kawamoto claims that the cost estimate accuracy of their tool ranges from 75% to 90%, based on the complexity of each case. It is offered to hospitals on a monthly subscription fee based on patient visit volume.

Professional Fees Not Included in the Tool

Many physician practices, specifically the ones owned by hospitals, according to Heather, want professional fees included in the estimate because it makes it more useful to patients. The tool has an in-built feature that enables users to request a hospital financial counselor to call and discuss the possibilities of loan or charity-care arrangement. 

According to Kawamoto, any patient concerns about their ability to pay are proactively addressed, entailing the patient to pay for the care.

Non-existent quality-of-care options

The only drawback of the tool is that it does not allow the patient to choose a range of quality care in their decision outcomes. This, according to Suzanne Delbanco, is one of the problems the tool seems to have. The other issue concerns the estimate consumers receive, according to Suzanne, the tool doesn’t reflect the full cost of care, it has some missing elements, such as professional fees, and an episode of care which may include unanticipated additional services. The bottom-line, per Suzanne,” the online price estimator is not the optimal choice for consumers, but it’s certainly better than nothing.

The administration of El Camino Hospital is in the process of identifying the benefits of the cost estimator tool, wondering if it has boosted the hospital revenue, Teri speaking to Modern Healthcare stated “We’re pretty excited that more than 3,000 consumers ran price estimates in one year’s time,” she said. Now it would be great to know if they actually came in for services.

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I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond Bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.

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