The Healthcare Financial Management Association's new Price Transparency Task Force has released recommendations for how health plans and providers should inform patients on estimated prices, out-of-pocket costs, in-network status and value.
"For too long it has been unclear how consumers should go about getting price information -- who to ask, what to ask for, or what the information even means when they do receive it," said Joseph Fifer, HFMA president and CEO, in a media release. "This approach is a game changer," he said of the industry-nurtured recommendations.
HFMA's Task Force-- comprised of representatives from insurance, hospital and physician associations and organizations like Florida Blue and Geisinger Health System -- is trying to tackle a problem that's been around for more than half a century but grew worse, or at least more apparent, in the past decade, as Americans took on more cost-sharing.
There are 13 recommendations in all and the first starts with insurers: "Because health plans will, in most instances, have the most accurate data on prices for their members, they should serve as the principal source of price information for their members," the Task Force wrote. "Health plans and other suppliers of price information should innovate with different frameworks for communicating price information to insured patients."
The "essential elements" of price information for insured patients should include more than just price, they argue: alongside total estimated price should be network status, related services that are often provided in tandem with the treatment or test in question, out-of-pocket responsibilities and other available provider service information.
While health plans should be the main source of information for insured patients receiving in-network care, the Task Force argues that providers should bear responsibility for informing uninsured patients or those getting out-of-network care at their facilities.
"Regardless of legal requirements, it is in a provider's best interest to be proactive in its approach to price transparency," but those should come with some qualifications for uninsured and out-of-network patients, the Task Force cautioned: "Clarify the limitations of the estimate" by explaining that complications may lead to increases, and identify inclusions and exclusions.
Much as health plans are being given responsibility for informing commercially-insured patients, the Centers for Medicare & Medicaid Services should develop user-friendly price transparency tools for seniors on traditional Medicare and work with states to do so for Americans covered by traditional Medicaid, the Task Force suggests. For out-of-pocket costs borne by beneficiaries of traditional Medicaid and Medicare, providers should offer the information upon request, the Task Force recommends.
The final recommendation is for physicians and nurses: "Referring clinicians should help patients make informed decisions about treatment plans that best fit the patient's individual situation. They should also recognize the needs of price-sensitive patients, seeking to identify providers that offer the best price at the patient's desired level of quality."
By some estimates, clinicians may be open to taking on this responsibility, especially if their sharing more financial risk. A 2011 Bain & Company survey found 80 percent of physicians agreeing that they have some obligation to help control healthcare spending, the Task Force noted.
On the whole, across the shared responsibilities of insurers, hospitals and physicians, the status quo needs to change, the Task Force argued in its conclusion: "The lack of price transparency in health care threatens to erode public trust in our healthcare system, but this erosion can be stopped."
"It's entirely reasonable for consumers to expect better access to price information," as HFMA's Fifer, a CPA and former financial officer at three Michigan health systems, put it. "We are calling on all healthcare stakeholders to acknowledge that and to deliver the clear, reliable price information consumers are looking for."