Intermountain revenue cycle VP: Hospitals are on the hook for price transparency

As patients face high deductibles, price is a major topic that's put pressure on healthcare providers to offer price transparency, even though what a hospital charges can be far different from what a patient actually owes after their insurance covers some of the costs.

"What are payers doing to make price transparent to members?" said Intermountain Healthcare vice president Todd Craghead, who leads these operations for one of the nation's largest health systems. "Nothing."

Craghead leads Intermountain's revenue cycle organization, overseeing $5 billion in annual gross patient revenue for 22 hospitals and over 100 physician clinics.

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Over the last 18 months to two years, Intermountain has seen a 13.5 percent increase in uncompensated care, and a 6.5 percent decrease in the numbers of uninsured due to the Affordable Care Act.

However, as providers have found, those getting insurance through the exchanges often have high deductibles.

"I think it's an interesting dynamic," Craghead said Tuesday during the Revenue Cycle Solutions Summit in Atlanta. "If payers are not supportive -- many suggesting they're not making margin on exchange products -- we as providers are getting left with a self-paid balance."

That means providers are responsible for what the patient will owe, Craghead said.

Hospitals and other organizations may promote looking up prices on their websites, he said. Yet the first question is always whether the consumer has insurance. If so, he or she is asked to call the provider.

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Intermountain is no different, he said. For the uninsured, the health system gives a 25 percent discount and another 15 percent if the bill is paid in advance.

"That's 40 percent in discounts," he said, "which is richer than any of our payers. Price transparency is about navigating to a place to get an estimate for them."

Given insurance information, Intermountain does price estimates for all pre-scheduled services, he said.

Consumers with a high deductible plan are asked how they're going to satisfy their obligation, Craghead said. Those without an answer are rescheduled until they can say how they're going to satisfy their obligation, he said.

There are exceptions based on medical necessity, and the hospital often sets up a payment plan.

"We've also done studies that suggest that if the individual with the high deductible has a health savings account we seek outcomes on that population similar to that of standard insured products," he said.

Education is needed for consumers choosing a plan on the exchange, he said, because without knowing their best option, people will select the high deductible with the lowest cost, he said. Putting its money towards the effort, Intermountain has helped fund a foundation that helps patients with the selection of exchange products.

Intermountain has already gone through revenue cycle integration.

"It takes about three years to change the culture," he said. "What's the value proposition of having a more consolidated revenue cycle approach? We've shown increases in yield and a reduction in cost to collect."

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Intermountain was up to 5 percent in the cost to collect and is now at 3.5 percent, a figure that is expected to trend up next year as Intermountain implements Cerner.

The yield has improved by 1 to 2 percent.

"The first half of this decade asks what are we going to do to optimize revenue and how do you leverage technology to optimize those paths," Craghead said.

Telehealth too will become a bigger player when in January it will be implemented around a primary care model for the Utah-based system.

Challenges remain for revenue cycle, which employs about 2,300.

The health system needs to build a more standardized approach to cut variation across the organization in patient experience, he said.

Twitter: @SusanJMorse