St. Cloud Shares Pricing, Quality Information
Each week, the managed care staff at St. Cloud Hospital in Minnesota fields calls from patients who want to know what it will cost them to visit the hospital. Some are expecting a baby. Others are having a knee replacement or some other type of surgery.
What these healthcare shoppers all have in common is a desire to know how much they will need to pay and whether this is a fair price.
Standardizing the Message
Up until two years ago, patients who called St.
Cloud Hospital to get a price estimate didn’t always land in the
right place. They might have gotten routed to surgery, X-ray, or even
administration.
“Nobody knew where to route the calls, so we had to decide internally who was going to handle pricing questions,” says Kathy Parsons, director of managed care. “We needed to be able to track the kinds of questions we were receiving and standardize the messages to patients.” The biggest concern was that patients would get the wrong answers and become dissatisfied when they learned the real cost of their procedure.
St. Cloud’s managed care department took on the role of handling pricing questions, and the hospital staff--operators, admissions staff, and the like--were told to funnel calls to one location. Currently, the department maintains a database of the top 25 inpatient and top 25 outpatient procedures. When a patient requests pricing for a procedure that is in the database already, then staff will calculate the price for the patient. Also, when a patient calls, staff will check contract terms and instruct patients to contact their insurer for benefit verification.
Web Site as Educator
St. Cloud Hospital, part of the CentraCare Health System, also
posts pricing and quality data on its
web site. Staff from quality, finance, marketing, and
government relations all played a role in bringing the quality
and pricing data online.
Pages dedicated to “Quality, Safety & Pricing” offer easy-to-understand resources designed to help put quality and pricing data in context. Featured are tips on how to judge quality, covering such things as the importance of the right physician credentials, technology use, and efforts toward patient satisfaction as well as an explanation of what quality scores mean.
In the spirit of transparency, patient safety data are presented in the same section as quality information. The data include the hospital’s adverse events, such as serious falls, pressure ulcers, and medication errors. Links to the latest reports on adverse events from the Minnesota Department of Health also are available.
Shedding Some Light on Success
The site also provides an opportunity for the organization to
call attention to some of its successes. For example, St.
Cloud’s laudable Press Ganey scores are on the same page that
lists Centers for Medicare & Medicaid Services quality measures. Viewers also see that from 2001 to 2005,
St. Cloud Hospital:
• Decreased patient deaths, complications, and adverse safety events
• Discharged patients almost a day earlier, while increasing patient understanding
• Increased its expenses by only 6 percent, while peer hospitals’ expenses increased 18 percent
Pricing information on the site is based on a cold feed of the hospital’s claims data by diagnosis-related group (DRG) to the Minnesota Hospital Association. For common types of inpatient hospital care, viewers can see how the organization compares in terms of length of stay, average charge, and average charge per day against all Minnesota hospitals and all Minnesota hospitals with similar patient volume. Information for outpatient procedures compares average charges among the same hospital groups.
Be Ready for a Conversation
When considering keys to the organization’s success with
transparency efforts, Parsons notes that members of the
hospital’s managed care team have been trained to use simple,
patient-friendly lingo when talking price. They avoid using
acronyms such as CPT and DRG.
Also, the organization welcomes opportunities to try to help patients make sense of their benefits. As an example, patients may not understand that the amount they pay for a colonoscopy could vary based on whether it’s a diagnostic versus screening service. A good pricing counselor should be able to help the patient navigate through such differences. “If you put prices on your web site, then you can’t just say ‘it’s out there,’” says Parsons. “The staff needs to be able to have a conversation.”
Excerpted from Hospital Strategies for Communicating Pricing and Quality. Click here to access this HFMA educational report (which includes several other provider case studies).