“We recognized that our industry needed to evolve to help patients understand up front what the cost of care would be rather than after we knew what services they consumed,” says Matthew Muhart, executive vice president and chief administrative officer at Memorial Healthcare System, a large public health care system in South Florida.
Both health systems have tools on their websites that quote prices for consumers who are uninsured (self-pay) or insured. The insured consumer completes a short form on Memorial’s website, entering the insurance company name and member ID, which the tool then verifies. At UCHealth, consumers visit their patient portal to access cost estimates. UCHealth has a video explainer for insured patients.
Both hospitals designed the online tools to include about 350 common procedures and services and all their insurance contracts. The tools connect to the individual’s health plan and member benefits and retrieves the costs for deductibles, including what remains for this year, copays, and co-insurance to calculate the total amount the patient will owe for a specific procedure or service after insurance is applied.
Memorial guarantees the prices quoted for 30 days. Muhart says rather than making patients pay for inaccurate quotes, he put the burden on his team to have accurate price predictions. “We’ve only had a handful of mismatches between predicted and actual prices, and in those cases, the hospital has absorbed the costs. Our consumers deserve fixed prices.”
Both pricing tools include a range of outpatient, inpatient, and technical services such as imaging and laboratory tests. For example, the top searches at Memorial are for labor and delivery, doctor office visits, bariatric surgery, general surgery, MRIs, lab tests, mammography work, CT scans, and ultrasound, says Muhart.
Weaver says UCHealth has a nearly 100% accuracy rate for estimates it provided for fixed services such as imaging and lab tests that are more predictable. For other services, the prices quoted are at least 90% accurate.
Both price tools exclude some professional fees from their price quotes. Weaver says UCHealth can provide fees only for providers it employs, which is nearly 1,000 doctors and advanced practice providers across its hospitals and clinics. Hospitals can’t include fees for contracted providers, due to federal anti-trust laws prohibiting them from accessing their contracts, Weaver says.
Memorial hasn’t tackled bundling all the services patients may receive from specialists such as radiologists, pathologists, and anesthesiologists. “In the future, we would like to provide a price quote for both professional and technical services,” says Muhart.
The digital tools are popular, according to website analytics. For example, nearly 10,000 unique visitors monthly click on the Memorial price tool page, including people in other countries, and the vast majority of comments are positive, says Muhart.
One user says, “I love the transparency and the information provided here. So often we are in the dark and we just do the procedure our doctors tell us to do without any idea what the cost is going to be.”
Another user commented, “Very impressive, I love it! I would love it if my healthcare system was this straightforward with the procedures offered. I always feel like it’s a wild card and I just hold my breath and don’t open the bill for a few weeks.”
A New Prescription Price Tool Increases Compliance
UCHealth is the first health system to build and put in place a prescription price tool. It partnered with RxRevu about 3 years ago to come up with the tool (SwiftRx Direct), which is embedded in the hospital’s electronic medical record system. Providers can check whether a drug they recommend to a patient is covered by the patient’s insurance pharmacy benefits, and if not, see what less expensive ones are covered.
Studies have consistently shown that 20% to 30% of medication prescriptions are never picked up by patients. “This is due to miscommunication between what the provider believes the patient needs and what the patient can actually afford,” says Richard Zane, MD, UCHealth’s chief innovation officer and a professor and chair of the department of emergency medicine at the University of Colorado School of Medicine in Denver.