Price Transparency Leader Pushes for Cost Estimate Accuracy

UCHealth continues to improve its cost estimator tool to ensure the highest degree of accuracy and avoid surprising patients with bills.

Editor's note: Earlier this month, we ran part 1 of an interview I had with Melissa Greer, vice president of revenue cycle at UCHealth in Colorado, who talked about the system's online cost estimator tool. This article is a continuation of that interview, covering the tool's accuracy dashboard, staffing the new price transparency call center, and educating patients about the tool. It has been lightly edited for clarity.

CMS Administrator Seema Verma recently named UCHealth as one of the exemplars providing price transparency that goes above CMS requirements.

Currently, UCHealth is providing estimates for 238 services and will up that number to 381 by the end of May, up from 38 when they went live in August. Soon, they'll add the capability for physician estimates, too.

UCHealth is not only adding more services to the cost estimator tool, but also making tweaks to ensure the highest degree of accuracy.

For instance, it found that providing estimates for low-volume services can sometimes produce a wildly divergent range of possible costs—for example, one case cost a patient $200 and another patient $2,000.

That's why UCHealth makes sure that there have been at least 15 cases of a given service at the health system before it's displayed in the tool. The health system also removes the cost outliers at the high and low ends, displaying the whole range except the top 10% and the bottom 10% "because they're clearly not the norm," Greer says.

UCHealth also recently went live with a dashboard that monitors every estimate and compares it to the ultimate amount that the patient was charged. Currently they can do a three-month lookback.

"We want to get to the point where patients can have absolute confidence," Greer says. "There's no sticker shock, no surprise bills."

Greer also says she would love to get to the point where they're automatically running estimates and sending them to patients, rather than waiting for patients to request them, as well as allowing patients to make payments from the tool.

Melissa Greer: We'd like to be able to be public about the accuracy rate. We want to be able to say, 'For this service, we are 99% accurate in the estimates we provide.'

For some of these services, I think we could be at 99% or 100%. If you're getting imaging, for example, there's not a lot of variability in the service that you're going to receive, and I think that we should be able to be extremely accurate.

That's why we put so much time and energy into the online tool. I think that's where we've differentiated ourselves. I think we have more services available on an online tool than anyone else in the country right now.

I would like to be to the point that everybody uses the online tool, and the call center is designed for those far-more complex services, or for patients that want some type of counseling.

We intentionally staffed our call center with financial counselors, and they can talk to patients about their high-deductible health plans and educate them on what they are and how they work, talk to them about exchange products, talk to them about assistance programs, [and] payment plan options—all of this in advance of the service.

Some services are really complex and could have a significant [price] range depending on a lot of patient factors. To me those are the ones that an expert on our side should be helping a patient navigate, versus getting an MRI or a vaginal ultrasound. These are things without variability. There's no reason a patient would have to talk to anybody about it.

HL: Can you please connect the dots about this for the revenue cycle?

Greer: The revenue cycle has a lot of components that are critical to this. Financial counseling typically lives within the revenue cycle. Financial counselors are typically either visiting patients in their room during an inpatient stay and helping them sort through things at that time or having conversations after services have occurred.

This [estimator] gets them up front in the process, and hopefully gets them to interact with patients in a way where they can be super helpful, using their expertise with patients who need that level of assistance.

Another strong correlation is that, as revenue cycle leaders, we run customer service.

We spend a lot of time and energy talking to patients after they've received a bill that they weren’t expecting to pay. I can tell you nothing is more frustrating to a patient than trying to navigate the system after the fact and being surprised and not being financially prepared. From a customer service perspective, that's first and foremost our passion around this.

Some services are going to be more expensive than others, and some facilities are more expensive than others. It's about being totally honest and transparent about that so the patient can make [an] informed decision before they receive a service. That's great customer service.

There are lots of others, too. Certain scheduling is part of the revenue cycle. As we schedule appointments, how nice it would be to not have the patient take the step of requesting the estimate?

There's lots of places within the revenue cycle where this applies, but to me it's using your financial counselors in the best possible way to serve your patients and improving the overall customer service experience, and bringing it up front—preservice—rather than trying to give them great customer service after they've received a bill that they weren’t prepared to pay.

HL: Have you noticed a difference in the call volume?

Greer: Honestly, not yet. Before we went live with this centralized call center, estimates were decentralized. They were provided at the individual clinics. We're aggressively working internally to make sure that they are triaging all those folks to us. We know that if they go through our call center, we're using a standard protocol—we're doing everything the same way, and we're using the tool 100% of the time, so we can use that dashboard to confirm accuracy.

I think our call volume has gone up since go-live [because] our internal folks have gotten better at sending people over to the call center to get estimates.

HL: How would you sell a price transparency initiative like this to your revenue cycle leader peers? Why is it worth the effort of going beyond the CMS requirements of publishing your chargemaster?

Greer: I would be shocked to find one person who disagrees with me that the chargemaster publishing is not the right way to serve our patients. That's not good customer service. That, to me, is not the solution.

[Leaders in revenue cycle] all run customer service, so they all should be highly motivated to give the best service to their patients.

Also, the vast majority of them are already investing in the tools that provide the infrastructure to do [a price transparency initiative]. It does take technical setup and work, but the primary tool that makes this meaningful is a tool called real-time eligibility: That is our ability to make that real-time call to the payer to get that benefit-specific information.

The majority of my colleagues use those tools today. They need to because that's how they verify a patient has coverage before a patient has [a service]. They're using these tools internally. So, they already do have much of the infrastructure. Many of them use Epic. [If] they've already paid for a robust tool and you've got a great partner, why not put energy into building out something like this?

I would be surprised if other electronic health record [vendors] weren’t trying to implement similar things. Much of what they need to do [a price transparency initiative] is already there. It's not like they need to go out and buy something to do this, it's probably within their electronic health record. And bottom line is it's incredibly better for the patients. It's just a totally different experience for their patients and a much better way to manager customer service.