Providing consumers with a retail experience in healthcare can help you comply with CMS’ price transparency rule and leave out the sticker shock of a charge master

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In a few days, you’ll need to be compliant with the Hospital Price Transparency and Disclosure Act of 2018. You can publish a charge master and fulfill your regulatory obligation. But is that the best strategy? Is simply complying going to help increase your volume and your revenues, especially when a charge master will likely result in sticker shock?

Organizations that operate by The Golden Rule usually satisfy customers and keep them coming back. Isn’t that what you really want? Compliance to the letter of the law will get you by, but will it satisfy your patients, people who are really your consumers?

Paul Keckley is a healthcare policy analyst and widely known industry expert. Keckley recently recounted his personal experience with the lack of price transparency and offers high-level insights into what needs to be done for consumers. We recommend reading his article, Hospital Price Transparency: The Long Road Ahead, in its entirety.[1]

We’re going to summarize and share a few highlights about how Keckley’s frustrations and suggestions can help you not only comply with CMS’ new price transparency law, but thrive and outdo your competition if you handle this in a way that will appeal to consumers.

In October, Keckley spent eight hours in the emergency room after collapsing on a golf course due to severe dehydration. He underwent an EKG and MRI to rule out heart and stroke issues. Five weeks after his ordeal, Keckley received his hospital bill for $13,529.05. Over $10K was for the MRI alone.

In an effort to understand the $10,655.85 charge for the MRI, Keckley searched for prices of “MRI neck without contrast” which was the way it was described on his discharge summary. He checked websites for the three local hospitals, which did not list prices, just requests to call a representative. Calls to the representatives resulted in no answers, not even an estimated range. Keckley then searched three price-shopper websites which offered both local and national price ranges, but according to Keckley, “the estimates varied widely and weren’t based specifically on CPT 3100F, the one used by the hospital to receive reimbursement by the insurer.”[2]

Oftentimes price transparency tools are clunky and don’t show true pricing. What is a consumer supposed to do with information that provides price ranges of MRI from $430 – $2409? It’s no wonder most consumers don’t use these tools. It’s important to note the distinction: using pricing tools is different than shopping for prices. People want to know prices. They also want an easy way to find them.

Keckley was frustrated with his experience for a variety of reasons that had to do with billing:

  • Separate bills
  • Meaningless line-item charges on the hospital bill
  • A lengthy, fruitless experience trying to make sense of the charges – including calling three local hospitals who couldn’t give him an answer
  • Feeling left out of the equation since the hospital billed his insurance before he had a chance to review the costs
  • Receiving the hospital statement five weeks after the fact

Obviously, an emergency situation is different than an outpatient event. And Keckley notes that: “Price transparency for a specific test is only relevant if it’s an outpatient non-emergency occasion where I am not directed to use a specific provider by my insurer.”[3]

But the billing processes resulting in Keckley’s dissatisfaction, are the same billing practices used across all of healthcare, including outpatient. Outpatient services are where you need to be competitive because people have a choice. How can you use CMS’ price transparency rule to your advantage? Follow the Golden Rule: think how you want to be treated when it comes to understanding and paying your healthcare bills and create an environment that provide that same treatment to consumers. Basically, give consumers the Amazon experience in healthcare.

What do consumers want?

  1. To know the actual price before the fact
  2. To know what type of discounts you offer
  3. To understand how they are going to pay and if you offer them terms or some type of line of credit
  4. Convenience such as access to telemedicine
  5. A retail experience like they are used to with everything else they buy

What consumers DON’T want:

  1. Not knowing what the cost will be before the fact
  2. Confusing bills
  3. More bills than they thought they would get
  4. Not being able to pay their bills

HealthQRS’ solution allows you to provide consumers with what they want: A true retail experience in healthcare. HealthQRS has developed the only complete e-commerce platform for healthcare on the market. We give consumers a site that allows them to use their smartphone, tablets or computers to shop, schedule and pay for services and medications and see actual pricing and options based on their health plans and networks. Our solution is simple to use. We invite you to see for yourself with this 2-minute video of the HealthQRS price transparency tool. Click on this link, then you’ll be instructed to download and watch: https://s3.amazonaws.com/hqrs.media/_misc/Screen+Recording+2018-11-29+at+17.30.45.mov

Our solution will help you comply with CMS’ Jan. 1 price transparency rule, but we are much more than a price transparency tool. Our platform has over 30 modules that work independently or all together depending upon your needs to provide a holistic, seamless, total experience for the consumer from start to finish. We combine navigation, the capability to make an appointment, referral management (if needed), payment management and so much more than we can list here.

HealthQRS’ price transparency tool allows you to publish price as well a downloadable readable file that shows realistic pricing, not the charge master.  In addition, we can provide out-of-pocket pricing. Our solution can also capture the user’s information, such as name, email address and phone number.

We enable telehealth connectivity as well. Our technology enables people to connect to more cost-effective, consumer-oriented healthcare options and we keep them in-network. HealthQRS integrates fully to your EHR and can also enhance your existing portals and other patient engagement solutions and improve your meaningful use numbers and increase meaningful use funds. Consumers can access your retail site and shop, schedule and pay for your services via an easy-to-use app on their smartphones or tablets.

We are a software-as-a-service (SaaS), so you have no capital investment, just a low monthly fee. HealthQRS can provide this to you for as low as $500 per month and we can have you compliant by January 1, and not only that, your facilities will be much more attractive to consumers than your competition who is publishing charge master prices.

Developing a solution of this magnitude didn’t happen overnight. We started with the consumer experience in mind and spent years drawing on the knowledge of best-of-breed experts to perfect, fine tune and put together this complicated, yet complete solution for medical e-commerce.

In fact, HealthQRS has over 15 years of experience developing healthcare retail experiences for people and our founders have over 50 combined years of e-commerce experience. We also invite you to watch our user-friendly app video that you can use to win consumers as well as our point-of-service solution video that may interest you. You can also check out our E-Commerce Medical Marketplace Flyer for more information.

Contact us right now to schedule a personalized demo. We can help you be compliant by January 1. Even more, we can help you give consumers what they want. And that will keep them coming back to you.

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[1] Paul Keckley, “Hospital Price Transparency: The Long Road Ahead,” The Keckley Report, Nov. 26, 2018, https://www.paulkeckley.com/the-keckley-report/?category=keckley+report

[2] Keckley, “Hospital Price Transparency,” https://www.paulkeckley.com/the-keckley-report/?category=keckley+report

[3] Keckley, “Hospital Price Transparency,” https://www.paulkeckley.com/the-keckley-report/?category=keckley+report

 

Patient portals aren’t saving the healthcare industry. The Amazon experience could.

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All over the country, hospitals are succumbing to unsustainable business models. Since Jan. 1, 22 hospitals have either closed or filed for bankruptcy. Larger providers like Ascension and Cleveland Clinic are also suffering from poor financial results. Blame is placed on many factors. But we suggest there is a common thread running through the financial devastation in healthcare: the failure to embrace consumerism and give people the Amazon experience in healthcare.

Many hospital leaders will say they are, in fact, doing everything they can to enhance patient satisfaction. They will show you their patient portals and the patient engagement efforts they have put in place. But notice the language: they are still calling their customers “patients.” And their answer to “patient engagement” is to give people portals.

People want to be treated like consumers, and money spent on portals simply isn’t paying off. Even though by 2015 nearly 90 percent of eligible providers and hospitals offered patients access to portals, by 2017, according to the Government Accountability Office (GAO), only “15 percent of eligible providers and 30 percent of hospitals saw any patients view, download, or transmit their patient portal data.”[1]

Portals are not a match for – or replacement of – an ecommerce platform that gives patients an Amazon experience in healthcare. They are not e-commerce platforms. People want to more than access their records. They want the ability to shop for services, see actual prices, schedule the services and pay (or at least make a down payment) from their smartphones. If they can also access their records from the same app, and communicate with their providers, and even see a teledoc, so much the better.

The HealthQRS app does all that. The HealthQRS ecommerce platform fully integrates with existing EHRs, allows patients to access their records, allows them to shop for healthcare services, and provides them the Amazon experience in healthcare.

A feature article about portals in Patient Engagement HIT says that “organizations are exploring how to leverage additional patient engagement technologies and feature to supplement the capabilities of patient portals and create seamless, holistic experiences for users.”[2] Really? With portals?

If providers are truly looking to create great experiences for users, then start treating those users like consumers and give them a retail experience in healthcare.

HealthQRS is not a replacement for EHRs. We are a complement that adds incredible value to the EHR.

We can partner and integrate with any EHR system to make it be everything you need it to be. We provide the front-end, retail shop at the point-of-service while your EHR continues to provide the necessary clinical and behind-the-scenes back office tools. We can be the value-added solution that provides a seamless experience, from start-to-finish, for your consumers and your employees. And, with HealthQRS there is no duplication of entry. Your staff doesn’t have to enter the same information into different legacy systems. We merge everything together behind-the-scenes and provide an easy-to-use retail experience for consumers and an easy point-of-service experience for your staff.

For example, many provider employees have to re-key everything they do because they don’t have one solution that automatically converges different systems. HealthQRS automatically posts payments to EHR systems. We automatically verify insurance, medical necessity, charity, our system can send all of that to your EHR.

HealthQRS gives you what you need to compete on many levels. Our solution provides people a full retail experience in healthcare just like they are used to receiving from Amazon for retail goods. From their smartphones, consumers can search for services and procedures in their network, see true prices – not just estimates – schedule the service, search for discounts, pay for the service or set up payment plans, find transportation, receive appointment alerts, wellness alerts, and even see a doctor via telemedicine. You name it. We offer it.

HealthQRS provides you with the infrastructure to create an online experience for consumers including accurate pricing (not just estimates). We enable telehealth connectivity as well. Our technology enables people to connect to more cost-effective, consumer-oriented healthcare options and we keep them in-network. HealthQRS integrates fully to your EHR and can also enhance your existing portals and other patient engagement solutions and improve your meaningful use numbers and increase meaningful use funds.

HealthQRS is the perfect vertical application for integrated delivery networks. We provide regulation compliance and serve as a marketing tool for your facilities. In addition, HealthQRS allows you to be compliant with the new CMS transparency rules beginning Jan. 1, 2019.

We are a software-as-a-service (SaaS), so you have no capital investment, just a low monthly fee. We also have a smartphone application that consumers can use to shop, see actual costs, schedule and pay for services with a few finger taps.

HealthQRS has over 15 years of experience developing healthcare retail experiences for people and our founders have over 50 combined years of e-commerce experience. We invite you to watch our user-friendly app video that you can use to win consumers. We also have a point-of-service solution video that may interest you. You can also check out our E-Commerce Medical Marketplace Flyer for more information. Why not contact us right now to schedule a personalized demo? Move beyond portals and give people what they really want. Treat them like consumers.

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[1] Sara Heath, “Moving Beyond the Portal with Patient Engagement Technologies,” Patient Engagement HIT, https://patientengagementhit.com/features/moving-beyond-the-portal-with-patient-engagement-technologies?eid=CXTEL000000260100&elqCampaignId=7078&elqTrackId=9b618c67503a467cb8ba9e2e737d0d83&elq=2c277b53f5b444fc855b17bb07adc73c&elqaid=7497&elqat=1&elqCampaignId=7078

[2] Heath, “Moving Beyond the Portal,” https://patientengagementhit.com/features/moving-beyond-the-portal-with-patient-engagement-technologies?eid=CXTEL000000260100&elqCampaignId=7078&elqTrackId=9b618c67503a467cb8ba9e2e737d0d83&elq=2c277b53f5b444fc855b17bb07adc73c&elqaid=7497&elqat=1&elqCampaignId=7078

Experian study reveals that 98 percent of consumers worry about covering healthcare costs

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An 85-year-old man named Bob had a total knee replacement just this week to help him deal with pain he’d had for 60 years due to a college football injury. Bob has Medicare as well as a Medicare Part D supplement. One of his sons accompanied him on his visit to the surgeon. When Bob asked how much the knee replacement would cost, the surgeon told him not to worry, that his insurance would cover it. Later, at the hospital, during pre-admission testing, a second son decided they should speak with financial counselors to get some idea of the surgery’s cost. “Well, our codes don’t really match the codes at Medicare, so I can’t really give you a true cost. I can ballpark it for you,” said the financial counselor. She reached out to her manager, had about a 10-minute discussion and came back. “I think it’s going to be somewhere around $2,400,” she told Bob and his son. They asked if this was just for the hospital bill. “Oh yes,” came the answer. “We have no idea what the surgeon’s or the anesthesiologist’s bills will be.” Then when told that Bob had a Medicare supplement, he was told they wouldn’t even be able to provide information about the hospital’s bill before the surgery. “But we have financial programs available to help you after the fact,” said the registrar.

This is a major IDN that uses one of the top EHR systems in the country. And they couldn’t tell Bob or his son what the costs of his surgery would be.

Now Bob is a conscientious gentleman and doesn’t leave any bill unpaid. In fact, when he gave his wallet to his son for safekeeping just before surgery, he told him that he had a blank check in there to pay for the hospital bill upon his discharge. But the reality? He won’t find out the true cost for the many services surrounding his knee replacement until he gets the bills about 60 days later. And it won’t be just one bill. He’ll get a bill from the hospital. From the surgeon. From the anesthesiologist. From the lab. And the list goes on.

True story. Happened in Louisville, Kentucky, but could have happened anywhere in America, because it does. Every day.

As this 85-year-old man undergoes a painful recovery, he will also be worrying about his medical bills.

And he’s not alone. A recent health study by Experian, that included a survey of more than 1,000 U.S. healthcare consumers, revealed the breadth of financial issues for healthcare consumers. One of the biggies? Almost all of the respondents (98 percent) ranked concerns about being able to cover out-of-pocket costs as a “very” to “extremely” important pain point during their healthcare journey.[1] Let’s look at the statistics from the study: [2]

  • 33% of consumers said they worried about determining their out-of-pocket costs versus what their health plan covers
  • 32% said they used the internet of mobile apps in the last 12 months to shop around for care
  • 28% said they worried about being ble to pay for medical tests recommended by their provider
  • 90% significantly underestimated costs related to major medical procedures, such as a knee replacement
  • 98% ranked concerns about being able to cover out-of-pocket costs as a “very” to “extremely” important pain point during their healthcare journey.

Think for a moment, about the increased stress levels of people worrying about their out-of-pocket medical expenses, which in the Experian study, is almost 100% of people. The American Institute of Stress says that stress can cause numerous emotional and physical disorders “including depression, anxiety, heart attacks, stroke, hypertension, immune system disturbances that increase susceptibility to infections, a host of viral linked disorders ranging from the common cold and herpes to AIDS and certain cancers, as well as autoimmune diseases like rheumatoid arthritis and multiple sclerosis.”[3] And that is just the tip of the iceberg. The American Institute of Stress goes on to say: “In fact, it’s hard to think of any disease in which stress cannot play an aggravating role or any part of the body that is not affected.”[4]

We have spoken with many large corporations who are tired of seeing their employees suffer from the stress surrounding medical bills, and especially the fact that they can’t figure out what their bills are going to be beforehand. They have told us repeatedly that they don’t want their employees forced to deal with provider portals because portals don’t provide meaningful information. These portals are piecemeal at best and only give estimates. They are not providing the users a good experience. They are looking for the Amazon experience in healthcare.

HealthQRS has developed an entire, seamless platform that can fully and easily integrate into EHRs to provide the retail experience that these EHRs do not offer. (And it’s not a portal because employers don’t want their employees to be forced into portals.) Our solution provides people a full retail experience in healthcare just like they are used to receiving from Amazon for retail goods. Because we are integrated with your EHR, you get the full benefit of reporting analytics which will improve your meaningful use numbers and increase meaningful use funds. We also have a point-of-service application that allows your registrars and financial counselors to answer consumer’s questions about financial responsibility in person or over the phone.

We provide accurate, true pricing (not estimates) for the entire procedure. From their smartphones, consumers can search for services and procedures in their network, see true prices – not just estimates – schedule the service, search for discounts, pay for the service or set up payment plans, find transportation, receive appointment alerts, wellness alerts, and even see a doctor via telemedicine. You name it. We offer it. Our technology enables people to connect to more cost-effective, consumer-oriented healthcare options and we keep them in-network.

HealthQRS is the perfect vertical application for integrated delivery networks. We provide regulation compliance and serve as a marketing tool for your facilities. In addition, HealthQRS allows you to be compliant with the new CMS transparency rules beginning Jan. 1, 2019.

We are a software-as-a-service (SaaS), so you have no capital investment, just a low monthly fee. We also have a smartphone application that consumers can use to shop, see actual costs, schedule and pay for services with a few finger taps.

HealthQRS has over 15 years of experience developing healthcare retail experiences for people and our founders have over 50 combined years of e-commerce experience. We invite you to watch our user-friendly app video that you can use to win consumers. We also have a point-of-service solution video that may interest you. You can also check out our E-Commerce Medical Marketplace Flyer for more information. Why not contact us right now to schedule a personalized demo? Follow the money and it will lead you to consumers. We can help you help the Bobs of the world, win them and keep them.

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[1] Kelly Gooch, “Financing their healthcare a big pain for many consumers, survey finds,” Becker’s Hospital Review, Sept. 5, 2018, https://www.beckershospitalreview.com/finance/financing-their-healthcare-a-big-pain-for-many-consumers-survey-finds.html

[2] Gooch, “Financing” https://www.beckershospitalreview.com/finance/financing-their-healthcare-a-big-pain-for-many-consumers-survey-finds.html

[3] American Institute of Stress, https://www.stress.org/stress-effects/

[4] American Institute of Stress, https://www.stress.org/stress-effects/

Azar’s price transparency mandate in healthcare is looming – are you ready?

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Providing true pricing transparency before services are rendered, helps not only consumers, but providers as well. Add to that a way for people to set up payment plans, and the hospital is much more likely to receive its money. When providers do right by the patients and publish true prices, they avoid issues of sticker shock and surprise billing. As a result, people know what the prices are. Not only do they go ahead and schedule the procedures, they pay for them.

Providers must learn from Amazon for consumerism to take hold in healthcare

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While hospitals are planning consumerism efforts, they are losing market share to the innovators who are already providing people satisfying experiences with convenience and lower costs. Amazon is the leader in customer experience. With continued innovation and disruption, the retail giant has proven again and again that those who remain in the status quo will lose. Providers who are slow to innovate and disrupt current business models will undoubtedly lose market share and possibly go the way of previous hospitals who have been forced into bankruptcy and closure.

Becoming a Center of Excellence for companies like Walmart

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Imagine if your hospital was the provider of choice for Walmart’s employees. Or any self-insured corporation. Think of the many benefits to employers and their employees (your consumers) plus increased business and revenue that would generate for you. Becoming a center of excellence will provide you with increased volume, which, will in turn, allow you to offer lower prices. This is a win for you, the employer and the consumer.

Ascension’s new strategy embraces consumerism

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For several months now, we’ve been asking how hospitals and other service providers plan to survive and compete in this disruptive market. Ascension has made news with its multi-layered strategic plan to do just that. One of the giants is waking up to the fact that traditional methods of healthcare delivery are changing, and they need to evolve their model. Part of Ascension’s strategy is to become less hospital-centric and to invest in telemedicine services as well as expand its reach in the revenue-cycle arena.