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5 Things to Know About Price Transparency in Healthcare & Surgery Centers

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As patients take on more financial responsibility for care, the criticism of cryptic or unclear pricing has grown. Patients have become consumers and are demanding increased knowledge of their cost of care before it is given. Here are five things to know about price transparency in healthcare and ambulatory surgery centers.

1. Physicians have opened up slightly more on the topic of cost. In 2012, 30 percent of physician regularly discussed cost of care with patients, according to the Medscape Physician Compensation Report 2013. In 2014, 32 percent of physicians reported regularly discussing cost of treatment, according to the Medscape Physician Compensation Report 2014.

2. Many providers are unsure of how to proceed, but the ASC industry has a number of trailblazers in price transparency. The Surgery Center of Oklahoma in Oklahoma City has had prices posted on its website for years. Keith Smith, MD, of Surgery Center of Oklahoma, has become a vocal supporter of price transparency and free market healthcare.

A number of centers have stepped forward to begin posting prices online as well. MEDARVA Stony Point Surgery Center in Richmond, Va., posted the out-of-pocket costs for up to 30 of its most common surgical procedures on its website. Before even opening its doors, Monticello Community Surgery Center in Charlottesville, Va., announced intentions to post procedure prices, including all fees, on its website.

3. Jeff Blankinship, president of Surgical Notes and Surgery Center Network, recently launched the direct-to-consumer surgical solution and educational platform, I Need a Surgery. The platform is designed to bring price transparency to the field of surgery. INS connects insured and uninsured patients with ASCs. The selected ASCs offer patients procedures at a pre-determined, all-inclusive price.

4. Price transparency is often coupled with cash pay. Patients using insurance are still left wondering what the final bill will say. Alongside the emerging transparency trend is the move towards bundled payments. Procedures with consistent, predictable outcomes, such as colonoscopy, are now being packaged under a single price. Bedford (N.H.) Ambulatory Surgical Center and Harvard-Pilgrim Healthcare recently launched a colonoscopy bundled payment pilot program. The bundled pricing is only available to Harvard-Pilgrim customers, but it is a step toward more transparency.

5. While individual facilities and providers are forging ahead with price transparency, the topic has garnered attention at the legislative level. California Assembly member Roger Hernandez (D) proposed a bill to create an online database for healthcare pricing. The Oklahoma Health Care Cost Reduction and Transparency Act of 2014 has been introduced. The legislation would require hospitals and surgery centers to disclose the pricing for the 100 most common diagnostic and surgical procedures, as well as the 50 most common imaging procedures.

In Massachusetts, a price transparency law went into effect in January, but meeting the requirements of the law proved problematic. Physicians and providers struggled to reveal the correct information in the correct timeframe. Price transparency is coming, but it may take time for the healthcare field to match the demand.

More Articles on Coding and Billing:
CMS Extends ICD-10 Partial Code Freeze to October 2016
9 Threats to ASC Revenue Cycle Management Success
From Now Until October 2015: The New ASC ICD-10 Implementation Timeline

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