Our cover story this month looks at how hospitals are managing the downsides of coverage purchased through insurance exchanges, one of which is the potential for debt driven by higher levels of patient cost-sharing in Bronze-level plans.
Newly insured patients may be unable to afford the high deductibles or co-pays required by these plans. And while it's too soon for hospitals to gauge the impact of these plans on their finances, it's not too soon to start talking about price transparency at board meetings.
Several health care organizations and industry groups, including the American Hospital Association, collaborated on a report published recently by the Healthcare Financial Management Association that offers recommendations to improve price transparency. These recommendations are based on the idea that patients should be able to easily determine the total price of a test or procedure, understand what is included in that price, have enough context to determine the value of the health care service and be able to make meaningful price comparisons among providers. HFMA also released a consumer's guide that defines terms, explains the impact of insurance coverage and suggests questions to ask providers, insurers and patient financial representatives.
These documents aren't solutions, but starting points. It's worthwhile to read them and note your own questions about the issue and your organization's responsibilities. For me, they raised this question: Is it reasonable to expect patients to do some of the legwork in determining what they have to pay for care? I changed my answer at least a dozen times, and I suspect you may feel ambivalent, too. It's time to start a conversation.