Ankit Kumar Agarwal
Ankit Kumar agarwal is a Wharton Graduate and working as “Director of IT” with NewWave Telecom and Technologies Inc. Ankit is passionate about bringing impactful changes in people’s life and writes blogs to educate people and promote digital Health.
What is Patient Cost Transparency
Patient cost transparency refers to the practice of providing patients with information about the costs of their healthcare services and treatments, including the prices of drugs, procedures, and tests. This can help patients make informed decisions about their healthcare and potentially lower their overall costs.
Patient cost transparency can be a valuable tool for patients, particularly those who have high deductible health plans or who are paying for their healthcare services out of pocket. By providing patients with cost information, healthcare providers can help them understand the financial implications of their healthcare choices and empower them to make decisions that are right for them.
There are a few key factors that can influence the effectiveness of patient cost transparency:
- The quality and accuracy of the cost information provided: Patients need accurate and up-to-date information in order to make informed decisions about their healthcare.
- The level of detail provided: Patients may need detailed cost information, including the prices of specific drugs, procedures, and tests, in order to make informed decisions about their care.
- The communication channels used: Patients may prefer to receive cost information through different channels, such as in-person consultations, phone calls, or online portals.
- The timing of the cost information: Patients may need cost information at different points in the healthcare process, such as before treatment, during treatment, or after treatment.
Overall, patient cost transparency has the potential to improve the healthcare experience for patients by empowering them to make informed decisions about their care and potentially lower their overall costs.
How will Patient Cost Transparency Transform the Healthcare Interoperability
Patient cost transparency refers to the practice of providing patients with information about the costs of their healthcare services and treatments, including the prices of drugs, procedures, and tests. This can help patients make informed decisions about their healthcare and potentially lower their overall costs.
There are a few ways that patient cost transparency can transform the healthcare interoperability landscape:
- Greater transparency can promote price competition among healthcare providers, which can drive down costs for patients.
- Patients who have access to cost information may be more likely to choose lower-cost options, such as generic drugs or procedures that are performed in an outpatient setting. This could lead to more efficient use of healthcare resources.
- Patient cost transparency can help patients understand the cost implications of their healthcare choices and potentially encourage them to adopt healthier behaviors that can prevent the need for costly medical interventions.
- By providing patients with cost information, healthcare providers can foster a sense of trust and transparency with their patients, which can improve the patient experience.
Overall, patient cost transparency has the potential to improve healthcare interoperability by promoting greater efficiency and transparency in the healthcare system, which can ultimately benefit both patients and providers.
Monetary benefits of implementing patient cost transparency
Here are a few examples of how patient cost transparency can provide monetary benefits:
- Lower healthcare costs: Patients who have access to cost information may be more likely to choose lower-cost options, such as generic drugs or procedures that are performed in an outpatient setting. This could lead to lower overall healthcare costs for patients.
- Reduced use of unnecessary or duplicative tests and treatments: By providing patients with cost information, healthcare providers can help them understand the financial implications of their healthcare choices and encourage them to choose the most appropriate and cost-effective options.
- Improved patient satisfaction: Patients who have a better understanding of the costs of their healthcare may be more satisfied with their care, as they feel more in control of their healthcare decisions. This can lead to improved patient retention and potentially lower costs for healthcare providers.
- Increased price competition: Greater transparency can promote price competition among healthcare providers, which can drive down costs for patients.
- Reduced administrative costs: Implementing patient cost transparency can also lead to reduced administrative costs, as it can reduce the need for manual price estimates and billing inquiries.
Steps to implement patient cost transparency
Here are some steps that healthcare organizations can take to implement patient cost transparency:
- Develop a Plan: Determine what information you will provide to patients, how you will provide it, and who will be responsible for managing the process. Consider the needs of your patient population and the resources you have available.
- Gather data: Collect and organize the necessary data on the costs of healthcare services and treatments. This may include the prices of drugs, procedures, and tests, as well as any relevant insurance information.
- Communicate with patients: Determine how you will communicate the cost information to patients. This could include providing patients with cost estimates prior to treatment, posting prices on your website, or offering in-person cost consultations.
- Implement Technology Solutions: Use technology, such as electronic health records (EHRs) or patient portals, to make it easier for patients to access cost information.
- Train Staff: Ensure that your staff is trained to handle patient cost transparency inquiries and to provide accurate and timely information to patients.
- Evaluate and refine: Monitor the impact of your patient cost transparency efforts and make adjustments as needed. This may include gathering feedback from patients and staff, as well as analyzing data on patient behavior and costs.
Patient Cost Transparency HL7 FHIR Implementation Guide
This IG provides detailed guidance for providers and payers to exchange data using FHIR-based standards to support sharing financial information for specific services and items. This exchange includes a provider submitting a Good Faith Estimate (GFE) to a payer and the payer generating an Advanced Explanation of Benefits (AEOB) for a patient, and optionally for a provider, to enable better decision making by the patient in consultation with the provider. Note: This exchange will be triggered via a “request” or “scheduled service”. The AEOB will also include the GFE used to inform the AEOB generation. This IG describes system interactions using the FHIR standard. This IG is informed by the No Surprises Act (see Division BB, Title I, Sections 111 and 112), which was enacted as part of the Consolidated Appropriations Act, 2021. The No Surprises Act specifically requires that a provider share GFE(s) with a payer and that a payer make an AEOB available to a patient in advance of service. The initial scope of this IG was inspired by this general requirement.
To ensure the IG supports all potential flows of information, the IG supports an AEOB being sent from the payer to the provider, in addition to a FHIR-based approach for the required flow from the payer to the patient. In this way, the IG can support providers and payers as they work to develop and implement a flow of information that allows them to meet the legislative and future regulatory requirement as well as enable information sharing valuable to supporting patient care. The IG is thus meant to facilitate the necessary data sharing without limiting provider and payer implementation options. The law does not require the use of an API to share these data. This IG provides an option for how to meet the requirements of the law, but the method used to share the required information – an API, a portal, e-mail, etc. – is the decision of the parties engaged in the process. Should future rulemaking mandate a specific scenario, this IG can be revised IG accordingly.
By using the FHIR standard and implementing this guide, providers and payers can enhance their existing technologies, where applicable, for estimating patient costs securely and efficiently using common open web technologies. The anticipated benefit of using FHIR APIs is to enable applications of the patients’ choice to give greater transparency into patient-specific estimated costs of expected healthcare services and items.
FHIR is being used for consumer access to healthcare related data at significant scale today, and there are regulatory requirements in the form of the CMS Patient Access API for FHIR support for the related use case of post adjudicated claims. Use of an industry standard would keep the barrier to stakeholder adoption relatively low.
Conclusion
In conclusion, patient cost transparency is the practice of providing patients with information about the costs of their healthcare services and treatments, including the prices of drugs, procedures, and tests. This can help patients make informed decisions about their healthcare and potentially lower their overall costs. Patient cost transparency can be implemented through a variety of methods, including providing cost estimates prior to treatment, posting prices on a healthcare organization’s website, or offering in-person cost consultations. It can provide significant monetary benefits for both patients and healthcare providers, including lower healthcare costs, reduced use of unnecessary or duplicative tests and treatments, improved patient satisfaction, increased price competition, and reduced administrative costs.
*This article is Peer Reviewed by the Distilinfo Editorial team prior to the publication.*
