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Navigating Price Transparency Requirements

Part Four - Conclusion & Results


Previous: Three - Price Transparency in Ohio


Transcribed Video Content Below


Basically this is letting you know where we’re going from here and lessons learned. And I think I mentioned to you what we thought would be extremely simple. It is from a technical perspective, but it's more complicated, or “comprehensive” might be a better word from a philosophical process.

So when we put this in, I mentioned philosophically what we were looking for: anonymity, and engagement, and independence. And what we found, as soon as we put this in, we weren't getting immediate hits. But as I mentioned to you, we had it under “financial assistance”. And it just helped validate that we really needed that button on that web page which we always wanted. And it really was a motivator for our web team to be able to get it expedited on the web page, even with their other projects that were going on.

Increases in Patient Estimate Volume Chart

So we basically, since we went live, we were able to have a 92% increase of utilization, which I'm going to say had a big impact basically on that button, on putting it on a landing page. So visual is extremely important. Also, we are about 0.5% to 1% [margin of error] around our estimates, which is excellent. Because we have knowledgeable individuals in combination with the claim history and the contract management that PMMC has provided us in doing these estimates, we're really proud that we stay very close to what we inform patients.

Now 1% can be a big difference depending on how big the bill is, but usually as I mentioned to you before, we give patients information that could cause that bill to be more. So there's still those surprises and I mentioned the implants. Bariatric surgery is another one that you never quite know what's going to take place once the person has the surgery. So we try to bullet items that could be exceptions.

Lessons Learned

We really want to make sure that we consider all the possible costs and as the question was before about supplies and implants and how we roll things up, we really don't leave much on the table, if anything, because we have the historical claims that we can look at and what the average is out of those claims.

And typically for similar procedures, if there's not a major comorbidity or complexity healthcare-wise, the average really winds up coming up very much the same. And if there are outliers, that tells us that that's what we need to inform the patient more about what type of outlier they could expect and possibly what those outliers may cost them; and to develop logical limitations when launching programs.

We really had to serve on a thought because we use an insurance validation software built into Epic that we would build it into PMMC, and we were very excited about that. And then when we actually looked at what that meant, if patients would have to answer all those questions, they would never get through the first page. So we decided that we could be extremely concise and not lag the patients out with a lot of questions that they may not even be able to answer.

So it was a great idea. Everybody would say, "yay" to it, even Patient Focus Group until we showed them what it would actually take. And even to try to default all that information back, they’d still have been able to address it, and so for now, we've put it on the table.

Future Plans

Of course, we’re going to add more payers and more procedures, but what we're going to do is extend the use to our sites that promote the same-day in non-emergent services.

We have seven centers that we consider our express cares, they're not urgent cares, where you can walk in without an appointment. This is an excellent opportunity to give an estimate right there real-time, while the patient’s there. And it takes no more than a minute or so. We're moving our portal to be in Spanish and also the estimates that come out of there.

We had a question that was “were we just going to print out the estimates in Spanish?” And, you know, when you asked that question, I think we all kind of grinned and said, "Well, how is that good? They’d have to read it in the first place?" So again, an obvious question may not have an obvious answer but we're going to have the website itself changed. And then also, we're working on getting the estimator linked to our self-service appointment scheduling and check-in that we have on the web.

And of course that isn't here but we are looking at it, is how we can integrate chat into the self-patient estimator, so that our patients, if they have any further questions, could just chat with one of our pre-service representatives. And then lastly, on slide 31, we basically are trying to stay ahead of Bill 52. And even though there hasn't been finality about “should we be posting charges?” What does that mean? What are the definitions? We're going to go based on how we provide our patient statements, which is a combined professional and technical statement.

And mostly likely post the real charges and then the allowable, and then the insurance payment, and then the adjustments and then the actual out-of-pocket because our patients like seeing that on our patient statements. And that were charges used interchangeably and actually PMMC, coordinated a meeting for many of us to discuss the labels and how those labels are being interpreted etc. so that we can all be proactive in meeting our patients' needs in the community before there's even a final decision as to what that actually means.


And I thank everybody for the opportunity. I think the last slide is showing my contact information. I love knowledge sharing and learn what others are doing so I can experience a lot of that best practice also. And I'm going to hand it back to Beth. Thank you, everybody, for your support and timeliness.

Poll Question and Q&A Session

Thank you so much, Donna. We would like to pause and share the results from our final poll. As a reminder, that question was, "Will your organization be changing price transparency efforts within the next 12 months in response to state legislation?"

  • •   50% of attendees said "Yes"
  • •   15% of attendees said, "No"
  • •   35% said "They weren't certain"

We have time for a few quick questions at the end of the conference today.

Q: First we have a question from Angela, who asked, "Does the PMMC estimator directly integrate with Epic?"

A: (From PMMC): I just wanted to add one thing to Donna's comment there specific to MetroHealth, we do have the ability to integrate with Epic. If that's your HIS, we do have the ability to integrate from a ADT standpoint and other aspects, including the patient accounting system to send information back, perhaps to an imaging system or whatever you'd like to discuss. A good question to speak to your PMMC representative about.

Q: Thank you. Our next question is from Anne and she asks, "Do you have a standard report you use to validate accuracy and how often does it run?"

A: Donna: We do have an audit report that validates accuracy. And we also always, if the consumer becomes a patient, we literally look at the claim that was produced and we compare it to the estimate. So that if it's not close to what we had considered, we can reach out to the patient and have a discussion first so there's no surprises.

Q: Thank you. We have time for one question left today. If your question was not answered, again, Donna's contact information is there for you. Our last question is from Erin, and she asked, "Is the 0.5% to 1% accuracy rate of the final total charges allowed amount or patient responsibility amount?"

A: Donna: That would be in reference to the patient responsibility amount, that's what counts. That's what the patient cares about.

Business partner webinar hosted with PMMC and the MetroHealth - Navigating Price transparency requirements, A Case Study in Adapting to State Legislation.