The Patient Price of COVID-19 Pricing Transparency Could Help Hospitals Rebuild Trust | Deloitte US has been saved
Limited functionality available
By Christi Skalka, managing director, and Chris Murray, senior manager, Deloitte Consulting LLP
The COVID-19 pandemic continues to test the accessibility of the health care system, both in its capacity to provide care and its ability to help patients understand the cost of that care. Recent regulations have made the public aware that some services, such as COVID-19 testing, are free to everyone who has health coverage. Those without coverage, however, could face large bills. Emergency-room visits, hospitalizations, and office visits might be covered, partially covered, or not covered at all, which has left some patients with questions…and large medical bills.
An increasingly frustrated public underscores the growing consumer anxiety in health care due to the lack of consumer-friendly information and the need for a transparent provider-patient dialogue around the cost of care. A final rule for providers slated to go into effect in January 2021 takes a critical step toward pricing transparency. The administration’s Price Transparency rule, which was recently upheld in court despite a lawsuit from the American Hospital Association (AHA), requires hospitals to publish a list of all standard charges—including negotiated rates with health plans and the lowest acceptable cash payment they will accept—in a consumer-friendly format. Hospitals and health systems that are looking to build trust and gain market share coming out of this pandemic should prioritize price transparency in their patient-engagement strategy.
The cost of care can be a major determinant of when or whether consumers visit a health care provider. Nearly 15% of Americans said the cost of care would keep them from seeking medical care if they or a family member had COVID-19 symptoms, according to a recent poll.1 When asked if they would seek care if they believed they had actually been infected by coronavirus, almost 1 in 10 respondents still said they would avoid seeking care. It’s likely that these respondents did not have access to consumer-friendly pricing information or understand that their doctor or hospital might be willing to negotiate the out-of-pocket price for services.
Will new rules lead to greater transparency?
Recent legislation enacted by Congress intended to remove cost barriers by making services related to COVID-19 testing completely free for most patients while requiring private insurers to cover provider costs. The new legislation aims to protect Americans from carrying any financial burden for services related to COVID-19 testing, yet many patients and insurance companies are noticing large variances in price for the same simple test.2
Even with the new regulations, some consumers are still being hit with large bills related to COVID-19 testing. Case in point: In April, a TV journalist reported on a young woman who received a COVID-19 test at a local hospital after experiencing a severe tightness in her chest. While the test came back negative, the uninsured woman received a $1,496 bill from the hospital a week later.3 This story underscores the need for hospitals to improve the way they communicate with their patients and their communities. A transparent dialogue around the cost of care could be enabled meaningfully through technology. Innovative organizations should leverage existing market technologies like interactive out-of-pocket estimator tools, digital front doors through the cloud, and interoperable and intelligent automation solutions to drive meaningful patient engagement.
We would never expect a consumer to purchase a phone or to book a hotel room without first reading quality reviews and determining whether it’s affordable. Why do we expect patients to feel comfortable taking these similar risks when seeking care?
The pandemic has changed the way patients interact with the health care system and it opens the door for innovative providers to build trust and engage more directly with patients as the crisis subsides. Stories about patients who received large bills for COVID-19 tests only emphasize the need for more transparency around the cost of care and more data-driven tools for patients to inform their care decisions. A Deloitte survey conducted at the peak of the pandemic found that 46% of insured consumers said the public health emergency led to a better understanding of their health care benefits. However, only 43% of respondents said they knew how to find the best and most cost-effective option for the care they needed.
As we crawl our way out of this pandemic, consumers will likely continue to demand more control over their health care experiences and costs. We expect innovative providers will act quickly on this opportunity to gain market share and boost net revenue by developing new patient-engagement strategies that prioritize price transparency between all market players. Hospitals, health systems, and other providers should consider the following steps to create a more transparent patient experience:
In the coming weeks, the US Centers for Medicare and Medicaid Services (CMS) will likely publish further guidance on how providers can help ensure their organizations are compliant with the January 1, 2021 Price Transparency regulations. As health care organizations begin to see the light at the end of the coronavirus tunnel, plans and providers should shift their focus and act swiftly and diligently—beginning with the steps outlined above—to capitalize on the price transparency imperative and best position themselves for long-term growth.
Acknowledgement: Elle Wilson
1. In U.S., 14% With Likely COVID-19 to Avoid Care Due to Cost, Gallup, April 28, 2020
2. Most Coronavirus Tests Cost About $100. Why Did One Cost $2,315?, New York Times, June 16, 2020
3. Coronavirus test comes with hefty price tag for uninsured San Diego woman, NBC7, San Diego, April 14, 2020