Why are self-pay charges still a black box?

Recently, my significant other got into a grappling match with my power drill. Let’s say, drill bit-1 and wife-0. This piece is a bit more opinionated and much more personal than usual (I hope). With both HIPAA and current employment in mind, let’s tap dance into describing an emergent healthcare experience and offer some context for making that experience one to remember.

We are fortunate to have four small to medium-sized healthcare providers in Atlanta (Emory, WellStar, Piedmont, and Northside). This forces quality competition amongst those providers. The Atlanta healthcare market is a great case study on free market forces working in healthcare. We were treated promptly and discharged with a few stitches and a wounded pride within about 90 minutes at the facility we attended. This aspect of the experience fully displays the beauty of American healthcare. You have an emergent event; you are seen promptly and discharged with no complications. Thank you, EMTALA.

Our family (2 humans, two canines, and a feline) is part of the generation that can take a chance on a High-Deductible Health Plan (HDHP) coupled with a Health Saving Account (HSA). That decision necessitates choices about how we get the care and ultimately pay for that care. This was not a life or death situation so that we could make those logical decisions. With that in mind, I asked our patient care coordinator for an estimate of our charges and the cash price instead of going through insurance. We are fortunate not to have chronic illnesses and do not anticipate hitting our deductible this year, the main driver for choosing a HDHP with an HSA. The estimate we received was given after all services had been rendered, and we were preparing to walk out the door. See Exhibit A.

Exhibit A

Fast-forward a week after proactively reaching out to the billing department to settle our debt, navigating our healthcare system came front and center. The front-line billing associate I dealt with obviously wanted this task off her desk, and it’s tough to blame her. Her task queue fills up with or without our emergent healthcare event. Unfortunately for her, the difference between the point of service estimate we received (after services were rendered) and the final charges was materially different, like a 54% difference, along with a slew of changes to their initial coding scheme. See Exhibits A and B.

Exhibit B

Thankfully, the art of negotiation is alive and well in the American healthcare system, especially for a self-pay patient. When you walk out the door as a self-pay patient, hospitals expect to receive about $.20 for every $1 owed. This might not be obvious to those who do not live and breathe healthcare but every hospital bill you receive is up for negotiation as a self-pay patient. They are for those insured as well, but that’s for another conversation. The bottom line is that hospitals welcome the opportunity to get $.25 on the dollar for that $23-dollar Ibuprofen tablet (See Exhibit B).

Why does getting accurate information to have to be so painful, though? If a healthcare system charges a premium ER visit for cost curves and some OTC pain meds, then make the self-pay patient experience as seamless as possible. As the first generation tasked with truly bending the cost-curve through vehicles like HDHPs, how can healthcare organizations provide the same value in experience as the monetary value we provide once the bill comes?OTC pain meds, then make the self-pay patient experience as seamless as possible.  

Something to consider, retail health clinics are simply going to create the infrastructure to capture these minor emergent event revenue streams if consumer preference and transparency are not being met in the traditional healthcare setting. It’s similar to how Athena Health and several other web-based, ambulatory electronic medical records providers came in and turned the Nextgen and Allscripts licensing-model worlds upside-down. Scale your strengths until the entrenched competition has to pay attention; by the time they do, it’s typically too late.

Healthcare has a vast supply of checklists for their staff to follow, as they should. Whether it’s pre-op, post-op, dietary restrictions, ADEIT, etc, etc. What about a checklist for patients during minor, acute healthcare events? So, the last mile for hospital organizations is creating transparent communication before, during and after care is rendered.

How can we align agenda’s better and help to create a little more health literacy out there?

Maybe this is a start:

• Explain the impact of going through insurance and not going through insurance
• Explain what charges, if any, could potentially spring up from the event post-discharge  
• Follow-up with the patient to understand how they are doing:
  • Are they in pain?
  • How are the stitches holding?
  • Does the hospital think follow-up visits will be necessary?
• Recommend signing up for your patient portal
  • Patient education around acute foot lacerations
  • Access to the X-Rays that we paid for
  • Electronic copies of our bills
  • Medication refills, as/if needed

Could we find this organization’s billing manager or director of revenue cycle services and make the case that we should be billed at a level 2 visit? Sure. Could we find the ER manager and discuss the lack of transparency in their existing processes for minor acute care events? No doubt.

It’s fantastic that healthcare organizations are beginning to inject patient care coordinator resources into the point of care. One more checklist and some training on the patient personas that will inevitably walk through your doors will create a better experience for consumers.. For context, one of our canines cut his ear three weeks prior to my wife’s event, which also required stitches. Our veterinarian team followed up three times after his procedure to check on Beck. Next day, one week, and ten days post-op. All for our dog and $500, which included teeth cleaning! We are still waiting for a phone call from this local healthcare provider to askhow she is doing.