Why are self-pay charges still a black box?

Recently, my significant other got into a grappling match with my power drill. Let’s just 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 very fortunate to have a collection of 4 small to medium sized healthcare providers in Atlanta (Emory, WellStar, Piedmont, and Northside) that obligates those providers to offer great care at a competitive price. The Atlanta healthcare market represents capitalism at its finest. At the facility we attended, we were treated promptly and discharged with a few stitches and a wounded pride within about 90-minutes. This aspect of the experience put on full display the beauty of American healthcare. You have an emergent event, you are seen promptly, and discharged with no complications. Thank you EMTALA and not living in Canada, ay!

Our family (2 humans, 2 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 care and ultimately pay for that care. This was not a life or death situation so we could make those logical decisions. With that in mind, I asked our patient care coordinator for an estimate of our charges and what the cash price would be as opposed to going through insurance. We are fortunate not to have chronic illnesses currently and do not anticipate hitting our deductible for 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 reach out to the billing department to settle our debt, the challenges associated with navigating our healthcare system came front and center. The front-line billing associate I dealt with obviously wanted this task off of 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 as a self-pay patient. When you walk-out the door as a self-pay patient, hospitals expect to receive about $.20 for every $1 that is owed. This might be 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 that are 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 the process of getting accurate information have to be so painful though? 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 that we provide once the bill comes? If a healthcare system charges a premium ER visit for 6 stitches and some 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 and by the time they do, it’s typically to late.

So, the last mile for hospital organizations is creating transparent communication before, during and after care is rendered. 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 and patient care coordinators in minor, acute healthcare events?

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 (crazy concept):
    • 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 (I’ll refrain from mentioning vendors because that cuts the list of the aforementioned health systems in half. 2 run Cerner and 2 run Epic).
    • 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 the billing manager or director of revenue cycle services at this organization 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 into their existing processes for minor acute care events? Maybe this post is that vehicle. Time is a finite resource and the amount spent lobbying to have our bill changed would undoubtedly end up costing more than the bill itself. That is not the point for us, thankfully.

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 your consumers. Imagine this, one of our canine’s cut his ear three weeks prior to my wife’s event and that required stitches as well. Our veterinarian team followed-up with us 3 times after his procedure to check on Beck. Next day, 1 week, and 10 days post-op. All that for our dog and $500 which included a teeth cleaning! We are still waiting on a phone call from this local healthcare provider to ask us how we are doing.

Published by Miers Q.

This website is a testament to the importance of our healthcare system and the importance our choices have on that system. I have worked in the health information technology software space since hanging up my baseball cleats. Hopefully this information can offer some unique perspective in a notoriously ambiguous industry.

One thought on “Why are self-pay charges still a black box?

  1. Yo Miers.  Nice job on this one,  I actually understand it.  Your line of reasoning made me think of Ross Perot.  He was an IBMer who realized that IBM was so focused on hardware that there was a huge void to be filled on the software side…which allowed him to become a billionaire.   Looks like similar avenues that can be approached on the billing side.   It’s not like people, healthcare customers, are not aware, but there is obvious opportunity for improvement.  Adding the personal touches of family and pets really adds to your assessment of industry.  Well done.

    Liked by 1 person

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