On January 1, 2021, hospitals in the US will be required to provide clear, accessible pricing information online about the items and services they provide. This is going to be excellent for US consumers (patients) as they will now be able to choose where they receive services based on expected cost, but since cost is not the only factor in choice, how is this going to impact ACOs? Can we expect patients to lower their own costs by having this newfound data?
First of all, knowing which hospitals have more competitive pricing should potentially make a difference in an ACOs yearly costs per member, but only if the patient actively considers price prior to visiting a hospital for any service. Furthermore, physicians will be able to see what the costs for hospital services are and will be able to assist patients with price-sensitive decision making. Hospital ER and inpatient admissions are sometimes unavoidable, but in many cases, they may have been preventable had the patient been seen by their primary care physician in the weeks or months prior to the event. Both types of events are very expensive to begin with and even more expensive when they occur at a hospital that is out of network for the beneficiary’s insurance.
It’s great that patients will be able to see which hospitals have the lowest costs; on the other hand, we can’t expect patients in an emergency to provide input on where they are taken to receive care. An emergency is stressful and often the patient has a condition that prevents them from being able to communicate any wishes on where they go. So while price transparency will prepare patients to make better choices when it comes to their non-emergency care, ACOs can’t rely on price transparency to impact their potentially preventable costs unless they actively work to prevent the events in the first place.
As a consultant for Salient Healthcare, I always recommend that providers focus on getting all their patients in for an annual exam, the Annual Wellness Visit. Not only is the Annual Wellness Visit an excellent opportunity for the primary care physician to assess their patient’s health, but it also allows them to address multiple quality measures that can help decrease the patient’s likelihood of ending up in the ER for an unplanned event. If performed consistently across their population, the AWV will also provide a steady stream of revenue for the provider while helping to decrease unexpected costs by early identification of health care problems. Another benefit of the Annual Wellness Visit is the opportunity for the provider to educate the patient on medications, lab results, how to care for any existing diagnoses and allow the patient to bring up any concerns the provider may not already be aware of.
Outside of the emergency services I mentioned above, price transparency is going to make a big difference in patients with disabilities and/or chronic conditions who have to schedule non-emergency medical visits on a regular basis. Perhaps the greatest impact will come from ACO providers taking the time to help patients better understand where they can go to receive the most effective care at the lowest costs.
Price transparency is no doubt going to create an even more competitive healthcare marketplace; however, the data shows that providers are more productive in reducing costs by focusing on providing the highest level of care that will reduce the number of unnecessary health events and their subsequent costs. Salient’s Performance Improvement Solution will enable your practice to better manage your AWV completion rate and other quality measures, please feel free to reach out. I would be pleased to demonstrate what Salient can do for your organization.