Author Archives: Vignesh Eswaramoorthy

Improve Your FQHC’s Operational Efficiency And Increase Your Revenue

Money inflow is very important for medical practices. Without a constant source of revenue, medical practices cannot pay bills, pay employees or take care of patients. It is no different for Federally Qualified Health Centers.

What are FQHCs and how do they operate?

FQHCs are community-based primary care medical practices. They provide comprehensive health care services for people of all ages, regardless of their ability to pay or health insurance status. They form a critical component of the health care safety-net as they provide

Primary care
Preventive care (oral health and mental health/substance abuse) services

FQHCs are also called Community Health Centers, Migrant or Homeless Health Centers, and 330-Funded Clinics.

The mission of FQHCs is to enhance primary care services to the underserved in both urban and rural communities. They operate as nonprofit entities under the guidance of a board of directors selected from the community where they operate. In return for providing care to the underserved and uninsured, FQHCs receive Federal government cash grants, cost-based reimbursements for their Medicaid patients, and malpractice coverage. These practices not only maximize the effect of the federal investment going to local patient care but also expands the impact of the Medicaid and Medicare programs.

Why should FQHCs concentrate on improving operational efficiency and increasing revenue?

FQHCs play an important role in supporting their community and providing care services to the underserved. Due to this, they may experience financial issues at uncertain times. When budgetary resources are strained, it is critical for an FQHC to

operate with maximum operational efficiency
preserve financial security
maintain staffing levels to continue operations

Inefficient and improper business processes will lead to patient dissatisfaction which will result in patients leaving the practice. FQHCs must concentrate on

Maximizing their business and staff efficiency
Minimizing financial risks

How can FQHCs improve operational efficiency and increase revenue?

FQHCs can improve business effectiveness and operational efficiency by making sure they follow these essentials steps.

1. Web portal for patients

It is important for FQHCs to take good care of their patients. Factors such as waiting time, improper schedules, referring to the wrong provider, etc create patient dissatisfaction. In order to prevent these, FQHCs should implement a web portal for their patients. Using the web portal, patients can access their health records, appointment schedules and choose providers based on their interests and preferences. When patients have the liberty to choose providers whom they can be referred to and also the appointment slot, they will show up for the appointments. Through this way, FQHCs can reduce patient-show rates, decrease referral leakage and also improve patient satisfaction.

2. Using technology

FQHCs prefer working with EMR/EHR systems because they are comfortable with it. So they do not wish to move out their EHR/EMR system. An EHR/EMR system has many advantages but when it is complemented with a Referral Management software practices can experience many more benefits.

How great it would be if a Patient Referral Management software could integrate seamlessly with an EMR/EHR system? It can help in ensuring end-to-end Patient Referral Management without disturbing the existing system.

HealthViewX Patient Referral Management solution provides easy steps to integrate with a practice’s EMR/EHR system. The patient demographics, diagnostic reports, test results or any sensitive information can be transferred safely. The solution is HIPAA-compliant with complete data security.

3. Improving staff behaviour

FQHCs must make sure that the people operating their front desk are friendly enough to deal with customers irrespective of their class status or bank balance. The more welcoming they are, the more the patients will feel comfortable and at ease.

Moreover, operational efficiency is the key to success. The more efficient the front desk operations team is at an FQHC, the more practice revenue the FQHC can generate. It can also help them facilitate additional patient visits; which mean that if more patients are adjusted and facilitated, the FQHC has the potential to make more money.

HealthViewX Referral Management Solution to aid FQHCs

HealthViewX Patient Referral Management Solution has the following features that aid FQHCs in improving their operational efficiency and referral workflow.

Outbound Referrals – HealthViewX Referral Management Solution can integrate with both the receiving and referring end. For inbound referrals, it helps in channelizing various sources into one single queue. In case of outbound referrals, it facilitates integration with the existing system to read the patient data and send out referrals.
Referral Timeline – In HealthViewX Referral Management System, any referral has a timeline, to capture and notify the progress of the referral to all the stakeholders. A referral will be mapped to a status which helps in tracking it better. With this, the providers can always be aware of how the referral is progressing.
Workflow and Task Management – A workflow can be defined on how the referral flow must be(business rules). Tasks can be created to manage referrals by assigning it to the respective person.
Improved communication – HealthViewX Referral Management Solution supports messaging and calling features for the referring and the receiving providers to stay connected.
Data Management – The solution is HIPAA compliant and enables secure data exchange of all patient-related documents.
Seamless Integration – The solution can seamlessly integrate with any EMR/EHR/RIS or Third Party application thus providing minimal disruption in the existing referral flow.
Referral History Consolidation – The consolidated data regarding the referrals and the referral history of any patient can be printed as a hard copy at any time in pdf/excel.
Smart Search – HealthViewX Referral Management solution has a smart search facility that helps in finding the right provider for the treatment required.
Referral Data Analytics – Referral data-centric dashboard gives complete data regarding the number of referrals flowing out, the number of referrals in various status, patient follow-ups, etc.

Having Trouble Maximizing And Managing Revenue?

Are you an FQHC facing difficulties in managing your business operations and workflow? Then you may have a revenue cycle problem. HealthViewX Patient Referral Management Software is custom-made to solve the challenges faced by FQHCs. Schedule a demo to know more about our solution!

How Can Federally Qualified Health Centers Improve Patient Engagement With HealthViewX Patient Referral Management Software?

Patient Referral Program in Federally Qualified Health Centers

FQHCs are high outbound referral setups, meaning they send out numerous referrals. A patient visits the clinic when he/she is suffering from an illness. Depending on the need for specialist examination or additional diagnosis, the PCP might refer the patient to an imaging center for further diagnosis or a specialist practice for advanced treatments.

Most of the FQHCs have a team of referral coordinators or RN’s, LPA’s, MA’s operating across various locations handling the referrals today. This team sends out referrals and ensures effective referral coordination. With the help of the patient demographics and diagnosis details available from the referral order, the referral coordinator does the insurance preauthorization and finds the right imaging center or specialty practice for the patient. Following that, the coordinator creates a referral that includes the details of patient demographics and the required diagnosis. Then the referral is sent to the relevant imaging center or specialty practice.

What factors plague the traditional referral process?

The traditional patient referral process in FQHCs are riddled with flaws. The primary shortcomings of the process are improper communication and the far-reaching consequences of follow-ups. Let us consider the following stats,

According to the Archives of Internal Medicine, only half of the referrals result in a completed appointment.
An Archives of Internal Medicine study shows that PCPs do not receive consult reports from the receiving providers about 40% of the time.
The Journal of General Internal Medicine found that 68% of specialists receive no information from the PCP prior to referral visits.
The Journal of General Internal Medicine found that 63% of PCPs and 35% of specialists were dissatisfied with the current referral process
An MGMA study found that 53% of Appointments with more than three weeks of lead time resulted in a no-show

Given these statistics, it is fair to conclude that PCPs are not satisfied with the existing referral program in Federally Qualified Health Centers.

Challenges in the existing referral workflow

The following are the most common problems faced by Federally Qualified Health Centers. Let us consider the challenges with a typical referral scenario to understand it better.

Finding the right specialist/imaging center – Due to the increasing amount of imaging centers and specialists, it takes a lot of time and effort for the referral coordinator to narrow down the referral coordinator’s search and find the right one. It is also less likely for an FQHC to have the updated list of imaging centers and specialty practices.
Insurance pre-authorization – The referral coordinator must check the pre-authorization requirements, health plans, etc. They must retrieve patient-specific data like the history of medications, medical diagnosis and insurance coverage. They must then send it to the insurance company to validate these records. This exhaustive process increases the burden for the referral coordination team.
Time Spent – As referrals are handled manually, a referring coordinator spends approximately half-an-hour to one-hour for creating a referral and even more time in following up.
Tracking the referral – Specialists are usually busy and do not have the time to inform physicians about the progress of referrals. This causes physicians to lose track of referrals. They get no information about appointments, referral loop closure, or feedback from specialists or patients.

Improve Patient Referral Workflow with HealthViewX Patient Referral Management

As per the report from the Journal of General Internal Medicine, referrals managed electronically are twice as likely to result in better referral adherence. This proves that web-based referral management optimizes patient satisfaction and care. HealthViewX has thoroughly analyzed the workflow of FQHCs. We have implemented the following features for many of our FQHC clients thus positively impacting their workflow.

EMR/EHR integration – Our System integrates directly with electronic health records (EHRs). This enables healthcare professionals to easily obtain prior authorizations in real-time at the point of care. It also eliminates time-consuming paper forms, faxes, and phone calls.
Insurance pre-authorization automation – There are two ways in which HealthViewX solution automates the insurance pre-authorization process. The first one is the API-based method. Through this, we retrieve information regarding the forms and communicate information back and forth between the FQHC and the insurance company. The second one is the Form Automation method. Through this, we get all payer-specific forms, fill in the necessary information and send it to the insurance company via e-fax.
Intelligent Provider Match – The system has a smart search feature that enables PCPs to filter receiving providers according to their preferences. The list is always up to date with the newly added specialty and imaging centers which makes it easy for the PCP.
To and fro Communication – The PCP and the center can communicate with the help of the inbuilt secure messaging and voice call applications at any time of the referral process. This allows physicians to get referral updates easily.
Referral Analytics – Customizable dashboards and reports provide information about the number of referrals sent, referrals in various statuses, referrals that were missed, processed and pending. It gives a clear picture for the FQHC and helps them in making informed decisions.

Web-Based Referrals Encourage Patients to Engage With Your FQHC

Patients can use electronic resources within HealthViewX Patient Referral Management System to contact providers regarding questions or concerns. This feature

minimizes unnecessary visits and re-referrals
improves provider availability for other patients who need an in-person appointment.

Electronic referrals also enable PCPs to spend less time on administrative tasks, giving them more time to engage with their patients. Web-based referral management improves accountability and patient satisfaction while reducing costs, allowing providers to effectively close gaps in healthcare.

Automating referrals and related processes enables practices to eliminate 70% of tedious administrative duties so they can focus on improving care delivery. Patients are more likely to schedule and keep appointments when physicians are consistently available and receive accurate patient information to provide optimal care.

Reference

https://www.mgma.com/getattachment/Products/Products/Maximizing-Patient-Access-and-Scheduling/PatientAccessSchedulingResearchReport-INTER_FINAL.PDF.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495590/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553012/

4 Ideas To Improve Your Patient Referral Process In 2019

Patient Referral Program in hospitals

An effective patient referral system plays an important role in large enterprise hospitals, specialty hospitals and health systems. It is an integral way of ensuring the patients receive optimal care at the right time by the right care providers.

Unfortunately, like a chain, a patient referral process is only as strong as its weakest link. Often referral systems are weakened by the use of old-fashioned fax machines to process referrals. It compromises the system and creates hazzles for providers and patients to navigate. This reasons why only 54% of referrals result in a completed appointment.

With focused efforts and the right resources, it is possible to enhance the existing referral process and make it more efficient and timely. The referral process must improve office practices and increase patient satisfaction and referral compliance.

Most common problem

Majority of healthcare providers experience major issues related to coordination or communication between relevant departments in their referral systems. These issues tend to have a bad impact on patient satisfaction, clinical care and outcomes.

For instance, according to the Journal of General Internal Medicine, more than two-thirds (68%) of specialists receive no information from primary care physicians (PCPs) prior to referral visits. According to the Archives of Internal Medicine, an astounding 40% of PCPs do not receive consult reports back from specialists following referrals.

Any referral inbound-heavy healthcare system would have faced the above issues. These issues would jeopardize an organization’s reputation, revenue streams and professional relationships. Referrals in inbound-heavy healthcare systems were often mishandled or dropped altogether, forcing referring providers, patients or their representatives to intercede and quarterback the referral process themselves.

It is recommended that such inbound-heavy healthcare systems require a standardized, enterprise-wide process for handling referrals. The healthcare system needs a better solution to support referring providers’ needs, which would significantly improve the handling of incoming patient referrals.

4 Ideas to Improve Patient Referral Process

The following steps can be used by any referral inbound-heavy healthcare organization interested in improving their referral process,

1. Identifying the current and desired state

Before defining what is needed for a desired future state, any healthcare organization must first review and assess their current state. The healthcare system must create a team to determine

How the current referral system works
How the current referral system is not fully competent
Where and how the existing referral process requires changes
Who would be handling such changes
What next steps are needed

Now the healthcare system can achieve the desired future state with ease as the current state is clear.

2. Charting the desired future course

The next action would be to chart and determine the various referral handling scenarios. These scenarios should range from the seemingly simple, such as a referral to an orthopedic specialist for a fractured limb, to the more complicated ones, such as the referral of a patient with multiple complex chronic illnesses. All possible types of referrals must be accounted for, to ensure that they would be handled appropriately and consistently.

3. Shifting to electronic referrals

Healthcare systems who receive referrals are heavily reliant on fax-based referral systems. These systems require staffers to manually re-enter referrals is time-consuming, error-prone and a major bottleneck. Instead, healthcare systems must receive referrals in electronic forms. Electronic referrals save time for staffers, less prone to errors and are also easy to manage.

4. Creating a new standardized process

The team should then create a new, standardized process for inbound referrals and leverage the referral benefits offered by electronic channels of referrals. Critically, this should include plans for internally training their staff members on this new process. It will also overcome referring providers’ previous impressions of the healthcare system mishandling patient referrals.

You Can Too!

By following the steps listed above, it is possible to see improved referral-handling within just a few months. More importantly a healthcare system must invest on the right provider portal like HealthViewX.

It will provider tremendous improvement in return on investment. Patient satisfaction will improve with easier and more efficient access to quality care. And physicians and staff will no longer need to engage in time-consuming and costly rework, data entry and investigations simply to ensure that referrals are correctly processed. A true win/win for all!

Reference

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686771/

How Can Large Enterprise Hospitals Overcome The Challenges In Patient Referral Workflow?

Did you know? There are about 8000+ large enterprise hospitals in U.S. Recently, Becker’s Hospital Review released the list of top 50 large health systems. How is a hospital classified as a large enterprise hospital?

Hospitals which have typically 500 or more beds are categorized as Large Enterprise Hospitals. They are capable of serving the broader needs of the community. Some larger hospitals offer a combination of acute and long-term care services while also providing research opportunities in some cases and accommodating a variety of specializations.

Considering the huge number of patients in such hospitals, the referral numbers are also high. So such large health systems face challenges such as operational inefficiency, patient dissatisfaction, care discoordination and missed referral updates in their referral process. Let us go through the patient referral workflow in detail to understand their challenges better.

Patient Referral Workflow in Large Enterprise Hospitals

In order to understand how a patient referral works in a large enterprise hospital, let us consider a scenario,

XYZ hospital is a large enterprise hospital with 10,000 plus PCPs and specialists. It is a busy hospital that sends and receives 1000 plus referrals in a day. In the workflow explained below, Mark is the patient who visits his PCP, Dr.James.

Mark visits the hospital – Mark hurt his leg and was bleeding. Even after three days, the wound did not heal. He visited his PCP, Dr. James. After examining Mark, Dr.James wants him to consult a diabetologist.
Dr.James does the insurance pre-authorization – The PCP does the insurance prior authorization manually. He places a request with the insurance company and waits for their response. The process takes time and forces Mark to wait. After about four hours, Dr.James gets the consent of the insurance company for the diagnosis.
Dr.James has difficulty finding the right specialist – The hospital had recently acquired a specialty clinic. Dr.James is not aware of the specialists recently added to the network. So he misses the famous diabetologist within the network and looks for someone outside the network. After considering many factors like the patient’s comfort, specialist’s availability, distance from the patient’s residence, specialist’s experience etc, he finally chooses a receiving provider.
Dr.James sends the referral – Dr.James finally sends the referral to Dr.Hales after trying to reach the specialist office via phone. The line seems to be engaged. He looks for many other ways which will be easy to send referrals but to his disappointment, Dr.Hales accepts only referrals through phone or website.
Dr.Hales schedules appointments – After receiving the referral, Dr.Hales schedules an appointment with the patient. Mark was not notified clearly about the appointment. So he fails to show up. It results in revenue loss for the specialist and patient dissatisfaction with the PCP. Mark who is still suffering from pain and waiting for the specialist to examine him. After two missed appointments, Mark finally visits the specialist.
Referral progress updates and loop closure – Throughout the referral process, Dr.James is in the dark. Dr.Hales is busy and fails to give referral updates to Dr.James. He is anxious to know if Mark was taken care of. Without referral updates, Dr.James cannot close the referral loop.

Challenges of Patient Referral Workflow in Large Enterprise Hospitals

Handling multiple EMR/EHRs – Large Enterprise Hospitals and Health Systems that are formed as part of mergers and/or acquisitions tend to handle multiple EMRs. EMR interoperability is their greatest challenge.
Finding the right specialist – A Large Enterprise Hospital has huge number of specialists. PCPs are not aware of specialists who were newly added or who came within their network as a result of mergers or acquisitions. So many times PCPs tend to refer their patients out of their network in spite of having the right provider within the network.
Patient no-show rates – When patients miss/forget or do not show up for appointments, it results in revenue loss for the hospital. Patients miss appointments due to various reasons like no reminders, waiting time, better specialist within the locality, reputation of the receiving provider, etc.
Referral leakage – Did you know? Referral leakage for any health system can average anywhere from 55-65%! Patient leakage or referral leakage occurs more in an out-of-network referral than in an in-network referral. There could be many factors such as reputation of a provider, lack of knowledge or insight and patient’s choice that lead to patient leakage.
Patient dissatisfaction – Large enterprise hospitals should keep in track of the number of patients moving out of their network. An alarming 25 to 50% of referring physicians do not know whether their patients see the specialist! Patients become dissatisfied with the treatment when specialists or PCPs do not follow-up with them regularly.
Referral Analytics – As a large number of referrals flow in and out of the network, it is difficult to track the exact number. It is also tedious to track the number of referrals in various status and to close referral loops.

HealthViewX Patient Referral Management Features for Large Enterprise Hospitals

Multi-channel referral consolidation – The HealthViewX solution can capture fax, phone, email, online form referrals or any other referrals in a single interface. It makes it easy to monitor and manage all channels of referrals in a single queue.
Intelligent Provider Match – The HealthViewX “Smart Search” feature makes it easy for the referring provider in finding the right provider. It has smart filters and search options that help in narrowing down the specialist based on the requirements. This saves a lot of time for the referring provider.
Insurance pre-authorization process – HealthViewX automates the insurance pre-authorization process. The provider need not coordinate with the insurance company for prior authorization. The HealthViewX solution will do it for them. This reduces the manual effort of the referral coordinators.
Patient coordination framework – After finding the receiving provider, the referral coordinator refers the patient. When the receiving provider receives the referral, the provider will get notified of the referral. Even the patient will be notified of the referral. The receiving provider can schedule appointments based on the patient’s comfort. This will cut down patient no-show rates.
Timeline View to track referrals – With the help of a referral status, the referring provider can get to know what stage the referral is. A timeline view shows a history of stages through which the referral has progressed. The chances of a referring provider missing out on referral updates are very less.
Referral closure and feedback – The referring provider can close the referral when it gets completed. The receiving provider and the patient can give a feedback on the referral process to the referring provider. Thus the referring provider can make it easy for the other the next time.
Referral Analytics – Helps in tracking the number of referrals and gives complete information about the referrals processed, missed, scheduled etc with the help of a Referral Data-centric Dashboard.

HealthViewX Patient Referral Management solution smooths the referral process and solves most of the inbound and outbound referral challenges for Large Enterprise Hospitals. Do you want to know more about HealthViewX HIPAA compliant Patient Referral Management solution? Schedule a demo with us.

Reference

https://www.beckershospitalreview.com/lists/50-largest-hospitals-in-america.html

https://www.mass.gov/files/documents/2016/08/uy/2011-hcctd-full.pdf

https://www.beckershospitalreview.com/lists/52-great-health-systems-to-know-2018.html

5 Benefits To Look For Before Choosing A Referral Management Software

Referral process in healthcare

A referral process in healthcare, a primary care physician creates a referral order in the EMR for a patient to see a specialist or imaging center for a specific medical service. PCPs hold the responsibility for managing and tracking their patient referrals throughout its life cycle. But the PCPs face challenges in managing the referral process. Challenges such as increasing patient referrals, new specialist and imaging centers opening up, manual referral follow-ups, etc prevent PCPs from managing the referral process effectively. This is when a healthcare referral management system comes to play.

Importance of referral management software in healthcare

There are many reasons for why having a referral management software is necessary. Healthcare processes are always criticized for being costly and inefficient. Referral management software is a potential solution to the healthcare problems. In this day and age, healthcare is moving towards improving quality and efficiency, while also decreasing the cost. It’s all about improving the experience for their patients. The entire industry is adapting technology for streamlining administrative operations.
Here are some alarming statistics that reiterate the need for a referral management solution,

Any health system will have an average referral leakage of 55-65%
Approximately 33% of patients do not follow-up with the specialist to whom they are referred
25 to 50% of referring physicians do not know whether their patients see the specialist
Over 50% of the current referral process is redundant and repetitive

In order to reduce referral leakage, increase patient follow-ups and improve the current referral process, a referral management software is needed.

Benefits a referral management software should deliver

The following are the benefits that a referral management software should deliver in order to make the referral process efficient,

1. Reduced referral leakage

Referral leakage is a huge problem hemorrhaging health systems in the country. Missed referrals are the main reasons for millions of lost revenue.
After implementing an effective referral management solution, the health system will see an immediate reduction in referral leakage. It will have a positive impact on the health system by making it more efficient and better equipped to serve patients. The immediate effect a health system will recognize is fewer patients leaving the health system thus saving millions in lost revenue.
Click here to learn more about how a health system can reduce referral leakage in their network.

“HealthViewX reduces referral leakage by helping referral coordinators in identifying the right receiving providers within the care continuum”

2. Decreased lead times

Operational inefficiency hampers a referral network to a greater extent. Dead time or unnecessarily long lead times are an inconvenience to both patients and providers alike.
For eg – PCPs frequently refer patients to specialists without considering the benefit for the specialty. About 65% of referral created by PCPs are unnecessary. These unnecessary visits will lead to long waiting times for those who do need to see a specialist. This will in turn result in poor health outcomes.
These problems can be solved by investing in a referral management solution. It will make the process efficient, decrease lead times, shorten patient waiting times and improve patient satisfaction. Increased operational efficiency will lead to shorter patient waiting times and thus more patients being seen.

“HealthViewX improves operational efficiency by automating the primary care to specialist referral process in healthcare”

3. Improved referral closure rates

With a referral management system in place, it is easy to track referrals depending on the status. Improved referral tracking leads to increased referral loop closures.

“With HealthViewX Patient Referral Management Software, health systems can track referrals in real-time. It provides a timeline view that helps referring and receiving physicians to know in which status the referral is.”

4. Improved referral utilization

Tracking patients’ progress through the care continuum helps to improve utilization for both providers and staff. Referral Management Software will enable health systems to see more patients.
PCPs can easily send patients to specialists by searching through directories and evaluating providers based on reviews, quality, and even familiarity.
It’s even better when this whole process can be condensed into one application, allowing both doctors and staff alike to access provider directories.

“HealthViewX Patient Referral Management supports features such as Intelligent Provider Match and Online Scheduling. It enables better utilization of the existing staff in health systems.”

5. Additional patient time

Finally, and maybe most importantly, referral management software must save time on administrative processes. This will increase the time for the actual medical visit.

Reference
https://www.mass.gov/files/documents/2016/08/uy/2011-hcctd-full.pdf
https://www.beckershospitalreview.com/payer-issues/3-important-statistics-about-provider-referrals.html
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160594

How Can Price Transparency Impact The Healthcare Industry?

Patient financial responsibility is the greatest challenge of healthcare industry. For a long time, healthcare experts have argued that price transparency will help patients in making informed healthcare decisions thereby decreasing healthcare costs.

In August 2018, CMS stated in its updates to the Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH PPS) final rules that price transparency will become a nationwide industry standard.

With effect from January 1, 2019, hospitals across the country are responsible for full price transparency. As per the IPPS and LTCH PPS rules, hospitals must list their prices online in a “machine-readable format.”

CMS approach to enforcing price transparency

Previously, hospitals were required to make their prices publicly available, but not necessarily in a digital format. In the new rule, CMS has mandated that these new price transparency resources be in a machine-readable format. CMS analyzed public comments on the most efficient way to achieve this. Finally, CMS called on all hospitals to list their chargemaster prices on a publicly-available Excel spreadsheet. The searchable spreadsheet will make it easier for patients to use.

Hiccups in the existing approach by CMS

Many questions have been raised about this approach.

Critics claim that charge master prices are not ideal for patients. Between insurance, subsidies, and other payment design, patients usually pay less than chargemaster price.
The feasibility of an Excel spreadsheet having all prices is a big question.
As more organizations publish their price transparency lists, more difficulties may come to light.

How can price transparency help patients?

Digital price transparency will enable patients to more easily access this information.
Price transparency will enable patients to make more informed decisions about care access that minimize their out-of-pocket costs and total expenditures borne by Medicare and Medicaid.
Increased price transparency will improve the patient experience of care.
Although price transparency itself cannot lower healthcare costs, but it may create market pressure that in turn lowers patient costs.
Additionally, price transparency will allow patients to choose the best care option for their needs.

The healthcare industry is still debating about the efficacy of price transparency. Healthcare price transparency tools have already made their mark in the healthcare industry. Do such tools improve patient experiences with healthcare or cut costs? How can organizations reconfigure these tools to increase its effectiveness?

Can price transparency reduce healthcare costs?

According to a 2016 study published in Health Affairs, it was found that price transparency tool actually increased out-of-pocket outpatient spending by about $59 per patient. The researchers suggested that it must must have been due to low patient awareness or perceived need of the tool.

Moreover, cost compare tools did not show many meaningful areas for cost savings.

Other studies have also shown similar results. A 2017 report by the American Journal of Managed Care found that though patients liked the idea of a cost comparison tool, they saw little use of the tool. They either forgot to use the tool before seeking care or did not see any use because they were already beyond their deductible or saw consistent copayments at their doctor’s office.It also touched on the idea of patient loyalty. Although patients could use price transparency tools to find a less expensive care option of equal quality, a sense of loyalty kept them going to their current clinicians.

Payers who offer price transparency tools have also had little luck with the tools. A 2017 report published by Health Affairs found that although scanning a cost compare website could result in 14% cost cuts for imaging services, only 1% of patients actually use the tool, making it of little use.

What do industry professionals say?

Although price transparency tools are not currently impacting the rising healthcare costs, these tools still have the potential to reduce spending and improve patient experience.

If properly utilized, cost compare technology should help patients cut their own healthcare spending because they know the lower-cost providers to visit. Patients with access to a price transparency tool have the opportunity to compare cost and quality and make their preferred treatment selection based on that data. Ideally, this will lead patients to a lower-cost option.

Clinics have little incentive to lower their costs when patients do not know how much they’ll pay before they receive the service. But if all clinics knew patients were visiting a high-quality facility with substantially lower costs, area competitors could be forced to change their prices, as well.

How can organizations make price transparency work?

Making price transparency tools that are attractive and usable for patients will be critical for delivering on the promise of cost compare. Simply offering a price transparency tool will not lower costs. Patients must actually use these systems to select lower-cost care.

As the healthcare industry continues to place more financial burden on patients, it will need to adopt strategies that help patients. High copay and high-deductible health plans have put patients in the role of the healthcare consumer. Price transparency tools are a key retail-style engagement strategy that will help consumers make better decisions about where to access care.

But in order to make those price transparency tools effective, industry leaders must keep the patient at the center of their design. Making a usable cost compare tool that uses simple language and factors in metrics that are important to patients will be integral going forward.

Reference

https://patientengagementhit.com/news/myhealthedata-patients-over-paperwork-key-in-cms-final-rules

https://jamanetwork.com/journals/jama/fullarticle/2518264

https://patientengagementhit.com/news/price-transparency-tools-receive-tepid-patient-reactions

https://patientengagementhit.com/news/4-patient-engagement-strategies-to-improve-patient-retention

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2016.1636