St. Joseph Regional Health Network, a Catholic Health Initiatives system in Reading, Pa., is providing pricing transparency and countering sticker shock with careful and thorough financial counseling for its patients. St. Joseph Regional Health Network publishes a lengthy list of the estimated charges of common procedures on its website. The price list does not include physician charges.
Prospective patients can scroll through the lists of procedures and see the high, low and median charges. For example, the median charge of applying a finger splint is $1,449. The median charge for arthroscopic shoulder surgery is $21,381. It's $37,676 for a nonemergency replacement of a pacemaker and $99,678 for a coronary bypass with a cardiac catheterization.
Those median charges are specific to St. Joseph Regional Health Network's charges for providing care to patients who have health insurance. The network has been posting the charges since 2008. The price estimator is on the St. Joseph Regional Health Network website, thefutureofhealthcare.org, as one of the selections under the "patients and visitors" tab. The web-based charge list tool is used by almost all of CHI's 87 hospitals in 18 states, but the charges posted by each are specific to that health center.
Countering sticker shock
The St. Joseph Regional Health Network has one hospital, St. Joseph Medical Center, and 16 outpatient centers in the greater Reading area. Mike Jupina, the system's vice president of marketing, said patient access representatives at the hospital use the price estimator to help patients better understand the charges for procedures for both inpatient and outpatient care. For patients with insurance, he said, the charge information can be used to calculate what the patient will pay out-of-pocket for coinsurance and deductibles. For those without insurance, it is a starting point to discuss financial assistance options, such as Medicaid or charity care, Jupina said. There also is financial assistance through St. Joseph, with payment schedules for the balance.
For the uninsured, many qualify for a 50 percent discount on the posted charges, Jupina said. But that could still be $10,766 for a replacement pacemaker.
"There certainly is sticker shock for a person who hasn't seen that sort of transparency in (pricing) before," Jupina said. "That's when we begin the process of financial counseling. It's a way to drive the conversation to help patients understand (their estimated financial liability) and how we can assist them."
Educating patients
Conifer Health Solutions of Frisco, Texas, hires and trains the patient access representatives who work at St. Joseph Medical Center and throughout CHI, Jupina said. TransUnion Healthcare of Chicago manages the price information. Conifer's training for the patient access representatives includes scripting for different circumstances.
"Our people are very sympathetic," Jupina said. "They aren't aggressive. The goal is to lay out the (patient's) costs so people can understand to seek assistance. We show them how they can deal with the sticker shock.
"Part of the challenge for all of us is to get people to understand that health care does cost money and that patients have an obligation based upon their financial ability," Jupina said. He said the hospital staff asks prospective patients to provide financial information to help determine what they can afford.
Improving care access
St. Joseph Regional Health Network serves Reading and the surrounding Berks County area, in the Pennsylvania Dutch country. Reading is about 50 miles northwest of Philadelphia. The city of roughly 90,000 has one of the nation's highest poverty rates, according to the U.S. Census Bureau. St. Joseph's combined uncompensated care and Medicaid revenue of 17.8 percent in 2012 is one of the highest in its region of Pennsylvania. "Many people forgo care because they do not have insurance, so you can imagine how many in our community would not seek care if we did not attempt to have these discussions," Jupina said. "What is important is helping people understand how to access care given their circumstances so maybe they can have a health problem addressed sooner before it becomes chronic or, perhaps, before it becomes impossible — and more costly — to treat.
"The mission of St. Joseph's continues to be caring for the people of our community without regard for their ability to pay. The estimator is a way for us to help people understand what health care costs and that we are willing to help," he said.
Jupina said providing financial assistance to those in need "is at the core of our mission."
He said the patient access representatives are learning about the changes brought by the Affordable Care Act to help patients understand them. Jupina said the hope is that the experience of buying health insurance through the new exchanges "will lead to an increase in patients' understanding of how their insurance works."
Michael Romano, national director for media relations for CHI, said the online estimator will become increasingly useful as more people are enrolled in insurance and become more knowledgeable about their benefits and their out-of-pocket expenses.
Industry task force calls for price transparency
In a report released in April, a task force of the Healthcare Financial Management Association calls for health care providers, insurance payers and employers to make a concerted effort to promote health care pricing transparency. CHA participated in the development of the report, "Price Transparency in Health Care," and the companion publication for the public, "Understanding Healthcare Prices: A Consumer Guide." Both are available at hfma.org.
"The lack of price transparency in health care threatens to erode public trust in the health care system," the task force said in its report.
The report sets out guiding principles for price transparency including that the information be easy to understand and presented in a manner that allows for ready comparisons among service providers. Price is an essential component of health care decision making, the authors said, and as patients take on more direct financial responsibility for health care in the form of higher deductibles and coinsurance, clear price estimates will inform their health care purchase decisions.
CHA's President and Chief Executive Officer Sr. Carol Keehan, DC, endorsed the report and consumer guide. "Transparency in price information is a reflection of our commitment to respect the dignity of the persons we serve," she said. "Patients and their families deserve complete information about their care and price information is an important component of what they need to make decisions about that care."
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