When patients receive medical care, a question naturally follows: How much is this going to cost me? It’s an important question for patients, but too often healthcare organizations cannot provide the answer until weeks after a visit. Organizations lack the technology to access and share cost information with patients efficiently, and increasingly complicated insurance contracts only make the problem more difficult to overcome. As the financial burden of healthcare continues to shift to patients, getting them the answer to this question becomes more and more time sensitive.
We recently spoke with Trevor Turner, M.D., a board-certified Physical Medicine and Rehabilitation physician. Dr. Turner works in a multi-specialty orthopedic practice where some of what he does is covered by insurance and some is not. He provided us with some key insights about the challenges standing in the way of price transparency through the lens of a physician — and what must be done to fix this problem.
When affordability determines care
Medical professionals want to provide good outcomes to patients, so it can be particularly frustrating when costs get in the way of the proper course of treatment. “The insurance marketplace is more confusing than ever for doctors and patients,” says Dr. Turner. “Between co-pays, deductibles, and denials, most people don’t have an accurate understanding of what healthcare is going to cost. But knowing what things cost becomes essential when making healthcare decisions because it often changes what doctors are able to offer patients to get better.”
Treatment plans are always built around providing the best patient outcomes but are sometimes being executed based on affordability. Dr. Turner recounts patients who have had to ask for surgeries to be done in certain locations — or even without anesthesia — in order to bring down costs. While this can sometimes be accommodated, many times it is unsafe or impossible and patients go without the treatment they need to fully recover.
Dr. Turner notes that in orthopedics, there are usually several options for treatment. Having accurate pricing available prior to procedures would make it significantly easier for physicians to build treatment plans that patients can actually afford and follow-through with.
Even physicians lack transparency
One major problem is that physicians are often called upon to be the authority about financial matters for patients — even though they themselves aren’t always fully aware of the costs of certain care. Dr. Turner says that, “as physicians have become employed we have less and less control of how much things actually cost. And because we have lost this control we honestly don’t know.”
Healthcare providers need real-time and easy to access cost and outcome information when they are in the room with patients, so they have an easier time answering questions and building treatment plans that fit patient needs.
Same procedure, different location
“We do procedures in the hospitals, we do procedures in the office, and we do procedures in the ambulatory surgery center,” says Dr. Turner. “Each location has a different cost associated with it, even though the procedure is the same thing.” To Dr. Turner, this is a shocking fact. We struggled and failed to think of another industry that offers an identical product that costs $1,000 in Location X, but $3,000 in Location Y.
Patients are savvy enough to see theses cost inconsistencies and demand the transparency they are so easily given in other industries. When they don’t get it, patient satisfaction plummets and they begin to shop around. Price conscious patients are the new norm and healthcare organizations need the tools to keep up.
The right technology is needed
“The best companies are the companies that provide transparency,” says Dr. Turner. “They let people know they’re getting what they’re paying for. And they’re confident enough in their care to be transparent.”
To cultivate this confidence, companies must invest in technology that seamlessly integrates medical and financial data to deliver pricing information to patients, physicians, and staff in real-time.