The world record for the high jump remained unbroken for years. Do you know what had to happen to break it? Somebody decided to try jumping backwards…Today we are going to look at how healthcare can jump backwards, not it time, but doing something totally different and far from its comfort zone.
My wife and I had finished having dinner at a nice restaurant and we were waiting for our check. The waitress brought it. I looked at the amount and it was only twenty percent of what I had expected. A moment later the wine steward appeared and laid a slip of paper on our table—forty-five dollars. In turn came the busboy, the sous-chef, the maître d, the dishwasher, the pastry chef, and the head chef. All told we received eight separate bills for our meal, and no single bill showed the total amount.
To say the least it made for a confusing experience.
When we bought our house, our bill—the settlement statement—showed what we owed down to the penny. We did not get separate invoices for the plumbing, the windows, the fireplace and the roof. We also did not get an invoice so detailed that it itemized every nail and every tube of caulk. Somehow those costs were folded in to other costs. Do you know how they avoided the problem of multiple bills, paid to multiple contractors with multiple terms? The builder acted as the general contractor.
It made for a much better experience than if we had been invoiced separately.
Since we all know where this is heading, I’ll head there quickly.
- There is no organization acting as the general contractor
- Multiple invoices from multiple vendors
- Different payment terms by vendor
- Different coverage by payer
- Excruciating line item detail—itemizing Tylenol
- Nothing showing what is covered and what is owed and why
- More complexity than a detailed IRS tax return
- Patients do not know what they owe and to whom they owe it
- Patients do not know what is covered and why other things are not covered
- Patients do not know what anything cost ahead of time
- Hospitals do not know their costs—they only know what they charge
- Two people having the same procedure at the same hospital will not be invoiced the same amount
The entire hospital billing process makes for an awful patient experience. Healthcare is the only service someone can purchase without having any idea what they owe and why. If the amount is large enough it remains an awful experience for months and years until the amount is paid.
I’m guessing, but I would be willing to bet that not one person in fifty in a hospital could accurately explain a patient’s total charges.
The entire billing process could be reimagined, it could be reinvented. And the reinvention could include a single bill. For those screaming at their PCs that it cannot be done, the only reason it cannot be done is that it has not been done, and that is not a reason.
Patient experience has to do with dozens of things that are very important to patients, things that hospitals have not changed in decades.
To be the hospital of choice you have to be the hospital people choose, and people will choose the hospital that is the easiest to do business with.
Such a stunningly simple concept that would, indeed, transform the experience of medical billing for patients. As I read this, I wondered why is it that patients have put up with this? We wouldn’t drop our car off for repair without first getting an estimate and having the right to authorize the work and be advised of any additional charges in advance. Your restaurant anecdote mirrors the process of receiving multiple bills for one event however it doesn’t quite capture the full story of healthcare billing…which would mean you sit down, order and eat your meal without seeing any pricing on the menu. We have stringent laws now to protect consumers with things like car repair, home repair, etc. Why are we not holding healthcare to the same standards when the financial implications have such major ramifications?
The next question then is how to begin a transformation in this area. These days it seems healthcare is most responsive when they equate something to impacting satisfaction scores. Time for health advocates and bloggers to share posts like this and remind the patient that the experience doesn’t end at discharge and how they are billed is part of that experience. Most likely, patient demand will need to drive the change in this area…so, let’s get started!
Thanks Tambre for reading and commenting
Perhaps we should extend this concept further. Billing and claims payment are really two parts of the same process, but they occur on different cycles, with different rules, by different organizations. Perhaps–especially with emerging reimbursement models that pay physicians and hospitals for performance, not piecework–we could also imagine a system in which claims and bills are reconciled and present to the patient with clear information about what was charged, what their insurance covered and why, and what they owe and to whom they owe it.
I couldn’t agree more Jan
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Sounds like a great problem to solve. I wonder if hospitals would be willing to give technology partners the access to data for analysis of costs and processes.
Kaiser approach is different though – patients are happier with predictable costs, and it looks like government is interested in Kaiser as an example for others.
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I know this is beyond the subject matter of your post, but reading about US healthcare I’m glad to live in a country where you don’t receive a bill for medical care at all. Never mind multiple bills!