There's no app for that: The human problem of price transparency

There is no shortage of vendors and IT solutions for price transparency. These businesses can offer pricing algorithms, estimates and mobile tools. But some studies released last week suggest hospitals have more work to do before settling on another app or piece of software.

Reading this study out of Massachusetts was like a blast from a past: It was nostalgically low-tech. Researchers called 22 hospitals asking for the price of a left-knee MRI. Hospital employees transferred their calls three to seven times. Once they settled on the right person, researchers then left messages on answering machines, waiting another two to four business days for a response.

The rigmarole took place with only phones and answering machines. Notice the lack of portals, iPhone apps and even email. If hospitals cannot wrap their heads around price at a level of interaction no different from the norm in 1995, should we expect any better with sophisticated technology?

A separate study published in the Journal of the Association of American Medical Colleges found something similar, although this one was conducted back in October 2012. Then, only a quarter of approximately 18,000 internal medicine residents knew where to find the estimated cost of tests and treatments.

Three years later, we can hope that figure would be a bit higher. Nonetheless, the basic language in the study is worth noting: 74 percent of residents did not know where to find cost estimates. This isn't about configuring costs, sharing prices with patients or factoring them into the treatment plan. It's about knowing where to look, and most residents failed.

This doesn't seem to be an IT problem, as much as prices and the revenue cycle are discussed with IT lexicon. Maybe the real litmus test for price transparency isn't the third-party tool a hospital makes available for estimates, but the number of times a call is transferred and how many days pass before someone calls back. Each of those phone calls is a test, an opportunity to ace or fail miserably.

In "Bitter Pill," journalist Steven Brill wrote that hospitals often treated prices like estranged relatives. "Although every hospital has a chargemaster, officials treat it as if it were an eccentric uncle living in the attic. Whenever I asked, they deflected all conversation away from it. They even argued that it is irrelevant."

It's easy to kitchen-sink price dysfunction, to blame it on the entire hospital and its hundreds of parts and people. But people feeling flummoxed about where to find price information suggests an communication problem stemming from the top of the organization.

Educating hospital employees and clinicians about price inquiries is perhaps the most important step in the price transparency movement. More than an additional website or app, it's feeling confident and ethical when answering questions that makes for a transparent culture.

Hospital executives and leaders have responsibilities not only to patients, but to their employees. As the debate about hospital prices ramps up, it's not fair for executives to remain insulated while the people answering phones take the heat.  

The men and women who answer a patient's call about the price of an MRI must hate their jobs in that moment, as they transfer the caller for the first of seven times. What hardworking professional likes to feel incapable on the job?

At the very least, hospital leaders should empower employees and clinicians by letting them know where to find price information. Protect them, educate them and do not leave them guessing. It's hard work, and perhaps not as hip as other solutions, but the need for it is not going away.

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