Transparency of Hospital and Pharmacy Pricing


With healthcare costs under deep scrutiny by politicians and the general public, doctors need to pay attention to possible changing laws and regulations. Many patients have their own horror story about a surprise on their medical bill, either from a procedure their insurance didn’t cover or possibly just surprised at the price of a single cotton swab.

There is an understanding that healthcare is not the same as other markets. The difference between trying to shop for services from your doctor and trying to find a good plumber outlines the problem many consumers face. Comparison shopping for healthcare just doesn’t work well as things currently stand.

Recent laws have mandated publishing your pricelist or chargemaster, but the implementation has varied widely. While we can make it more clear where pricing is located on your website, without further detail, that isn’t going to mean much to a patient beyond a general comparison of which procedures cost more than others. When it comes to their pocketbook, patients need to know the negotiated rates between the healthcare provider and the insurance company to make an informed decision.

Additionally, a lot of services cannot be shopped for. While a patient might be able to find the pricing for specific kinds of surgeries for instance, they lack the knowledge of how incidental prices on a procedure can rack up. Even if the patient had a list of everything they would eventually be billed for, in an emergency, they simply don’t have the time to go through each line item and try to see if they can reduce their cost.

Above all, we need to remember that most patients don’t spend their days in the world of medical finance. Providing them with an understanding, is one of the most critical things we can give them.

So, what can we do?

To start, we can set expectations. Medical bills are never great to get in the mail but preventing the surprise that comes along with the charges will go a long way in relieving stress for patients.

Prices already need to be published, however let’s take that a little further: make pricing easier to find and revise the web page in order to help your current and prospective patients understand each item on the pricelist. From there an explanation as to why they are priced the way they are can help reassure patients with insurance and help patients who are uninsured or underinsured. You can be a trusted resource not only as it relates to their health, but to their pocketbooks as well.

Many insurance companies or providers have tools to show estimated costs for procedures. This is often presented as an estimated range for the cost of the service. While it may not be possible to shrink the range, ensuring the lists and tools are functioning and up to date will prevent confusion.

Some of the easiest items to focus on are the steady costs that patients genuinely can shop for. Items such as pharmaceuticals, elective surgeries, and even certain kinds of scans are the types of services where it’s very important to have them listed clearly. When patients ask about, schedule, or confirm appointments for these items it is also the best time to inform them about the price comparison tools they likely have access to, but have never utilized. Showing the accurate cost of specific items can be very reassuring and build trust, which equates to a longer patient/doctor relationship.

Lastly, there is a discussion you should be involved in about one of the most important aspects for patient choice. Value comparisons about the cost of services is meaningless without knowing the quality. Quality information about services are far less conspicuous than most would like, or than is even useful. Right now, shopping for healthcare is similar to shopping for a smartphone without any of the gadget review websites.

Healthcare providers should be very involved with how quality ratings and reviews are implemented and used to judge. While some may try to construe a higher price as providing higher quality of care, patients aren’t likely to trust such a claim implicitly. We need to come together as a community to provide a transparent format for quality metrics that will help patients comparison shop with understanding.

All of this can feel like a lot of work on top of an already demanding job. It’s asking that you change the way much of your office or hospital operates.  Being proactive is not just good for the consumer but is good for your business. If we don’t alleviate patients’ anxiety around healthcare costs, it’s likely they may seek alternative care.

To learn more, check out How to Make Healthcare More Transparent - Lively and InphoniteVoice SaaS.

Lauren Gramlich