By Tim Charles / Guest Column
The new year brought a new nationwide hospital regulation. The Centers for Medicare & Medicaid Services asked that, on Jan. 1, hospitals post the price of services online to bolster price transparency.
Mercy Medical Center in Cedar Rapids has voluntarily made charge information available online through the Iowa Hospital Association for the last 12 years, so we were well prepared to welcome this important regulation to our already robust price-transparency tools for patients.
Rising health insurance costs and high-deductible plans, now commonplace, have prompted patients to shop for health care. They weigh options, with quality, safety and cost driving a lot of decisions. Mercy saw this trend coming and adopted the Iowa Hospital Association’s Iowa Hospital Principles for Transparency in support of price and quality transparency. In 2007, our hospital charge information became available through the association’s public portal that allows patients to search inpatient procedures, see associated charges and compare hospitals.
Providing clear facts about the costs associated with medical care, and making that information easily accessible to the public, is absolutely essential in today’s health care environment. With that said, it’s also important to understand the difference between the price tag on hospital services and the amount a patient may actually pay out of pocket for those services.
Think of the hospital’s price as the sticker price of a procedure. Now, think of health insurance coverage or financial assistance programming as tools that may cover some, or all, of that sticker price for the patient. A lot of variables go into figuring out what costs may remain after those tools have been applied. For example, different procedures may be covered at different percentages or rates, diagnoses may have an influence on policy coverage, people carry different co-payment and co-insurance amounts – all are factors to consider when examining standard charges and what portion may actually come out of a patient’s own pocket.
It’s vital that patients have a good grasp of their health plan coverage when looking at service costs and, whenever questions arise, feel comfortable talking with health insurance carriers about plan coverage. Talking with health care providers about diagnosis codes and procedure codes can help patients get even more accurate answers from insurers, too.
At Mercy, we employ financial counselors who strive to ease this stress for patients who need help figuring out what portion of costs they may be responsible for paying. Based on patient-provided insurance information and codes tied to procedure and diagnosis, financial counselors can estimate the responsibility of medical services provided at Mercy, helping patients have a better understanding of how the care they receive may affect their pocketbooks.
These health care advocates, coupled with a Billing & Insurance section on mercycare.org, create a network of support designed to offer as much clear information as possible.
Hospitals have a responsibility to comprehensively care for patients, which includes financial health, too. As patients and employers investigate online price information, ask yourself what could make the information better, clearer and even more beneficial, then share your feedback with providers.
At the end of the day, it’s about offering meaningful price information that can help patients make the health care choices they feel are best. If you have thoughts to share with me, I welcome them. I can be reached at tcharles@mercycare.org.
Tim Charles is president and CEO of Mercy Medical Center in Cedar Rapids.
