Most people wouldn’t think of buying an expensive item, such as a car or house, without performing extensive research and price comparisons. Yet, when it comes to healthcare services, comparison shopping has historically been nonexistent.
The executive order mandates that healthcare providers publish the cost of medical procedures before consumers receive them. The president’s actions could bring about a significant overhaul of the healthcare industry.
How the executive order could transform healthcare
In the traditional healthcare delivery model, patients tend to pay little attention to the cost of services until they receive a bill. Consumers have had very limited access to cost information prior to making healthcare purchasing decisions and, as a result, are unable to compare prices.
If enforced, the executive order will ensure healthcare consumers can get information about pricing before visiting their doctor or receiving other medical services. This includes:
Cost of a procedure
Price negotiated by their insurance company
What they will be required to pay out of pocket
By knowing the cost of a medical service upfront, patients can make more informed buying decisions.
Healthcare providers could get support in this effort from the executive branch. The current administration is looking to help providers develop tools that give patients more access to healthcare prices; it will also improve quality of service measurements and make them public. In addition, the Department of Health and Human Services (HHS) has been tasked with researching other barriers to transparency in healthcare costs, including developing regulatory steps to address “surprise” billing.
For example, many hospital emergency rooms are staffed with out-of-network doctors. Patients who go to an in-network hospital (as designated by their insurers) may not realize they’re getting treatment from out-of-network physicians. Following treatment, patients are shocked when they receive a bill for thousands of dollars more than they expected to pay. Part of HHS’ research will focus on making sure consumers can get information that will help prevent “surprise billing.”
RELATED: Hospitals, insurers signal major fight over CMS price transparency proposal
To develop more responsible healthcare consumers, key stakeholders—including healthcare, tax and benefits professionals and employers—are making efforts to provide the information, financial incentives and decision-making tools patients need to make educated decisions.
To improve consumer transparency, insurance providers are starting to make it easier for patients to determine costs. Many now provide a cost estimator application on their websites for patients to estimate treatment costs upfront. Health systems have also begun publishing quality information on their websites so consumers can make quality-of-service comparisons before choosing a provider.
At the same time, health savings accounts, flexible savings accounts and health reimbursement arrangements provide consumers with tax-advantaged financial tools that get them more involved in their healthcare decisions. Using these accounts to pay for healthcare expenses enables consumers to gain a better understanding of their healthcare costs.
For hospitals and large medical practices, transparency relates to more accessible information about resource costs, patient outcomes and internal quality improvement initiatives. It also means improved communications and collaboration between all departments within the organization.
Recent efforts by elected officials and the move to healthcare consumerism represents a major cultural shift. Everyone involved—government, healthcare providers, insurance payers and patients—wants the same outcome: higher quality medical care at a lower cost.
More transparency and healthcare consumerism could be the combination that gets us there.
Thomas O'Banion is the marketing communications manager of DataPath Inc.