• Moving Toward a More Consumer-Friendly Future

    By Joseph J. Fifer, FHFMA, CPA Aug 10, 2015

    In the retail sector, one-stop shopping has evolved to become one-click shopping. Are we close to achieving that in health care

    Joseph J. Fifer, president and CEO, HFMAIn a word-no. But that doesn't mean we shouldn't move in that direction. In a one-stop/one-click shopping experience, consumers would be able to obtain up-front price estimates for all aspects of their treatment-not just the acute care piece. Patients getting a knee replacement, for example, would know how much they will pay out of pocket not only for their hospital expenses but also for physician's fees, physical therapy, prescription medication, rehab care, and other related expenses.

    Making the best of the current system

    Apart from a very few totally integrated systems, virtually no providers have the ability to provide price information across all care settings today. What we can do-what we should do-is be up front about our limitations. HFMA's price transparency guidelines call on all stakeholders to do exactly that. Specifically, providers and health plans should tell patients to expect separate bills from each entity involved in their treatment and should inform them about potential out-of-network charges. The objective is to avoid surprise bills. (When it comes to bills, surprises are rarely a good thing.)

    Can we envision a day when patients can get out-of-pocket estimates for an entire healthcare event This is a reasonable request, from a consumer standpoint. Can we picture a future where financial data, as well as clinical data, are accessible by all parties involved in a patient's care One thing we know for sure: With the growth of bundled payment and other value-based payment models, price information will become more integrated-and thus more convenient for consumers. The bar is continuously being raised.

    Moving toward a one-click future

    In the clinical setting, our industry has long recognized the value of exchanging information and coordinating activities across care settings. Inadequate care coordination, including management of care transitions, has been linked to an estimated $25 billion to $45 billion of expenditures for avoidable complications and preventable readmissions.a The article "Innovation With Care Transitions" in this issue highlights innovative practices in this arena. For example, in New Jersey, the HackensackAlliance ACO acquired a web-based platform that allows it to create and share a global patient care plan. The plan spells out coordination activities for the entire team. It alerts care coordinators about an impending patient discharge so they can help ensure a smooth transition. In general, the HackensackAlliance ACO strives to support patients as they move between care settings. As the ACO's president and CEO Morey Menacker, DO, puts it, "The transition of care can be an anxiety-filled time."

    Care transitions can be times of anxiety from a financial standpoint, too. Even though we're a long way from making transitions financially seamless, we can certainly start improving them. It's not hard to imagine using a tool like Hackensack's web platform to alert finance staff to prepare patients for the financial transition to another setting of care. It's not difficult to envision apps that would prompt patients and finance professionals to ask questions (or supply answers) about the financial aspects of a care transition. The key is to start looking at all of this through new eyes-that is, through the patient's eyes. The separations between care levels are neither natural nor intuitive to patients. A patient basically wants to know what she will pay to get a new knee, or to have a baby, or to return to work after an injury. It's that complex, and that simple. The easier we can make this for consumers, the better off we all will be.

    Joseph J. Fifer, FHFMA, CPA, is president & CFO, HFMA. Follow Joe Fifer on Twitter @HFMAfifer.


    a. " Health Policy Brief: Care Transitions." Health Affairs, Sept. 13, 2012.

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