Patient Pricing Transparency Movement Hits Stride

Pricing transparency is becoming a game changer for patients, providers, and employers. It has to be.

The rise of high-deductible plans means, more than ever, patients are being forced to manage their flexible spending accounts carefully. In turn, patients and employers are pressuring providers to lift the secret veil that has clouded its prices in mystery for a long time, in order for them to go "comparison shopping," said Cheri Kane, managing director at PriceWaterhouseCoopers (PwC).

Kane, along with Stacey Lee, senior associate at PwC, will talk about the rise of patient pricing transparency at the 2015 Medical Group Management Association (MGMA) Annual Conference, held in Nashville, Tenn., from Oct. 11-14. The panel, "Are You Ready for Patient Pricing Transparency," promises to touch on all the nuances of this complicated issue.  It is scheduled for Wed., Oct. 14 from 8 a.m. to 9 a.m. Central.

"Physicians are not prepared for [price transparency] and the hospitals are not prepared for it," said Kane, in an interview with Physicians Practice previewing the session.

One of the complicating factors around patient pricing transparency, and why physicians may not be ready for it, is regulation. While the federal government is strongly pushing this ideal with various measures, such as annual Medicare charge price data dumps, there are no laws requiring it nationally. On a state level, some have considered making it a requirement but few have acted. Even in Massachusetts, where it's law, the results are less than ideal because physicians are unclear on the requirements they are facing, said Emily Anne Nolte, a senior associate at PwC.

A nonprofit organization, the Catalyst for Payment Reform, released a report card on pricing transparency by state, and all but five failed. Only New Hampshire got an "A." Massachusetts was one of the 45 states that failed, due to a lack of a public transparency tool.

"What we found is that most states have very vague references to price transparency, saying something to the effect of, 'You need to submit charges or claims data to the state for research purposes, '" said Nolte.

Even when they know they have to post charge prices, physicians, especially in smaller practices that deal with lower-cost services, are hesitant to be more transparent, said Nolte.  Revealing a charge price for an office visit, which is typically not what a patient pays, could turn on off patients.

Opportunities Abound

Despite this, the PwC research team sees opportunities for practices to leverage pricing transparency to market to fickle-minded patients. Kane said patients trust providers more than insurers. This factor should give them a leg up in transparency, even though payers have been the one push forward on this issue.

"It's a huge opportunity for providers to start building pricing transparency because no one really trusts their insurance company," said Kane. "People trust their providers; the providers have the relationship. It's an opportunity for them to share the price, help them through that price, and develop that loyalty. If not, patients are going to start turning to the payers."

Providers who are not taking advantage of this movement will end up losing patients, said Kane, especially the younger population. "Patients will pay more for a better consumer experience," she noted. "We have to do a better job of supporting them through that process."

One of the ways practices can take advantage and improve the consumer experience is through adding value at various patient touch points, said Lee. "For example, if a patient calls in and asks for a price quote, that's a touch point and an opportunity to hook that patient in," she said.

Kane and Lee will discuss more opportunities for practices during the presentation, as well as oversight of the aforementioned regulatory issues. For providers who believe this is a trend du jour, think again, said Kane.

"This is not going away," she said.

Kane and Lee will be featured speakers of "Are You Ready for Patient Pricing Transparency," a session at the MGMA15 conference in Nashville on Wednesday, Oct. 14, 2015 at 8:00-9:00 a.m.