Description

Price Transparency

The rising cost of healthcare combined with higher co-payments and out-of-pocket expenses place a tremendous financial burden on patients and families. Although patients are encouraged to be partners in care and share in the decision-making, they often asked to do so without full knowledge of their financial responsibility for health services.

It is critically important that patients understand their options. Clinicians are ideally suited to help patients choose the best treatment. Though they consider managing costs important, they too lack financial understanding of healthcare, or financial literacy. Subsequently, effective conversations about out-of-pocket costs rarely take place.

A recent article published in the NY Times (Appleby, 2018) describes a situation where a diabetic patient was encouraged to attend a diabetes self-management class scheduled for 2 half-days. He received a letter stating that there would be a charge but was not informed of the amount. The letter stated that the amount the patient would pay was dependent on the patient’s insurance coverage.

The patient received a bill for $1,004. After the hospital billed the patient’s insurer, the charge was lowered to $625. Because the patient had not met his annual deductible, he was responsible for the entire $625.The patient stated he would not have attended the class had he known the price since he had already paid $120 for a one-on-one session with one of the hospital’s certified diabetes educator.

What if you were the nurse executive responsible for the Diabetic Self-Care Course – what action would you take after hearing the patient’s complaint? If you lowered patients’ out-of-pocket expense, what “opportunities” exist for cost savings that could be used to subsidize the program?

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