EXECUTIVE SUMMARY
Patient access can follow several steps to make it more likely that patients who price shop to get estimates for costs of procedures will choose their hospital.
- Ask patients if a lower-cost estimate they received covered all charges.
- Inform patients that facility, anesthesia, or other charges are not always included in hospitals’ estimates.
- Give patients specific information on expected costs, as opposed to general information.
When price-shopping patients call multiple hospitals to inquire about costs, they’ll probably get a different dollar amount from each of them. The problem is these numbers don’t tell the whole story. Sometimes, they’re wildly inaccurate.
“We have cases where patients tell us they have called other facilities and they gave them an estimate for a lower amount for the same procedure,” says Monique Gatterson, supervisor of patient financial services at Seattle-based Virginia Mason Medical Center.
Not surprisingly, patients want to know why Virginia Mason’s estimate is so much higher. “We suggest patients call the other facility back and ask, ‘Was that a complete estimate?’” says Gatterson.
Often, patients discover the quoted amount only covered professional charges. Facility charges or anesthesia charges often are omitted. “This means their actual out-of-pocket obligation could be hundreds of dollars higher,” says Gatterson.
Virginia Mason recently implemented a patient cost estimator tool that gives patients a comprehensive estimate of their out-of-pocket costs. “This includes all expected services involved in their medical procedure,” says Gatterson.
‘Big Dissatisfaction’
Previously, staff relied on a homegrown estimator tool to give price estimates. “It was an Excel spreadsheet we’d populate with a CPT code. It would give you the total charges,” says Gatterson.
When a patient asked for an estimate for surgery, for instance, the tool calculated the total cost of the procedure. However, this was of little use to patients who wanted to know their out-of-pocket costs.
“The number really was not meaningful at all,” says Gatterson. Many individuals complained they could not financially plan without better information about what they’d owe.
“This was a big dissatisfaction for patients. We wanted to turn that around,” says Gatterson.
The new patient cost estimator tool gives more accurate estimates, and factors in contracted rates with the patient’s insurance provider, deductibles, coinsurances, and out-of-pocket maximums. “It takes all of those numbers, and populates the total estimated charges for the procedure and the patient’s amount,” says Gatterson.
Move to Transparency
About half the calls handled by Virginia Mason’s financial navigators are from patients asking for an estimate. The department has made costs more transparent in multiple ways.
“Price transparency, and helping individuals understand what their out-of-pocket cost will be, reflects our commitment as an organization to putting patients first in everything we do,” Gatterson explains.
In addition to providing estimated out-of-pocket costs, Virginia Mason posts the estimated prices of its 100 most common minor outpatient surgical procedures on its public website. Patient access recently implemented a trial process for contacting patients ahead of time to offer cost information proactively.
When calling to confirm surgery dates, schedulers asked patients, “Would you like an estimate of your out-of-pocket costs?”
Surprisingly, not everyone did. “We actually didn’t have an overwhelming response from patients who wanted this information ahead of time,” recalls Gatterson.
Some people were just too anxious about their upcoming medical procedure to think about finances. Patient access employees don’t push the information, but they do make it clear it’s there whenever patients want it.
“We explain how they could get the cost estimate information whenever they were ready,” says Gatterson.
In addition to providing estimates for out-of-pocket costs, the team helps patients set up payment plans or apply for financial assistance. The organization is also exploring pre-payment options for insured patients.
“We have an important role in the patient experience,” Gatterson says. “This is a responsibility we take seriously.”
- Monique Gatterson, Supervisor, Patient Financial Services, Virginia Mason Medical Center, Seattle. Phone: (206) 341-1747. Email: [email protected].
