Transparency Requires Service Definitions (3)
Larry Ozeran, MD, FAMIA
Strategic Consultant for Health Informatics, Organizational Governance, Health Policy and Software Development
The prior post briefly mentioned the importance of comparing similar services. If a laparoscopic appendectomy at one facility includes one night observation but not the use of endoscopy support services, it can’t really be compared to a similar service at another facility that includes both or a third facility that includes neither. There are several different coding systems used for the billing of healthcare services today and if physician services and facility services might be combined in this new era of price transparency, a new set of definitions is required to standardize services and differentiate them from each other. Rationally, it makes sense to reuse as much of what exists as possible. Here is one proposal, define a minimum set of services that would constitute all billing from the time a patient enters the facility until they leave it. Identify what existing billing codes that service includes and total the price. Have standardized add-on services that also use existing billing codes. Share the base service information and the add-on services with the patient at the time of any request for price information.
If this were implemented, each of the three aforementioned facilities offering laparoscopic appendectomy would have a base price for the outpatient service including the use of anesthesia and endoscopy services. Each would also have add-on services for hospitalization, transfusion, identification and management of unforeseen pathology or complications. This list of add-ons can get long, so it should be available online with detailed explanations so that computer-savvy patients (a large and growing percentage of patients) can understand and compare services on price. Similar to existing travel service aggregator websites, a business model might develop to make the process even easier for individuals to compare different facilities and clinicians.
Less complicated services, like a telehealth or office visit, might have a single per-time-unit price.
What do you think? How would you propose making price transparency a reality?
Prior: What is Healthcare Transparency? - Next: Transparency Must Start Somewhere
Human Factors Engineer | Chief Research Informatics Officer | VP Research & Innovation | Consultant Advisor
1 年Interestingly there is price transparency in the dental domain, at least on the part of my dentist and oral surgeon. I got a full estimate for a dental procedure with a single price for the main procedure and options for anesthesia with prices for each. This is what we need in the broader healthcare space.
All of this gets much easier for the patient if we transition most elective or well-defined services into bundled payments.? ?The patient sees one price and the "add-ons" are the provider's responsibility.?