St. Clair Hospital’s online price transparency tool allows patients to get up-front estimates of their out-of-pocket costs.

This year, St. Clair Hospital in Pittsburgh launched an online tool that allows patients to receive out-of-pocket estimates, specific to their own insurance benefit design and deductible status, for 105 healthcare services.

Recognizing that price transparency is increasingly important, most health systems are working to provide reliable out-of-pocket estimates prior to delivery of elective services. For several years, St. Clair staff both responded to patient calls about procedure costs and made outgoing calls to patients scheduled for elective surgeries and other procedures to notify them of their estimated out-of-pocket responsibilities. Its new approach marks a step forward because it allows patients to obtain out-of-pocket estimates at their own convenience without interacting with a health system staff member.

Although St. Clair is in a highly competitive market, it did not adopt the new technology to support price shopping. Rather, hospital leaders want patient experience—in both clinical and administrative interactions—to be on par with clinical quality.

“We are a national leader in quality and in patient satisfaction, and we want to be a leader in health care broadly,” says Alan Yeasted, MD, St. Clair’s chief medical officer. “Our website includes information on quality and patient satisfaction, so this is just completing the circle of transparency for our patients.”

How Patients Access the System

When prospective patients click on “patient estimates,” they see “In three easy steps, you will get an up-to-date estimate of costs (deductible, co-insurance and co-pay), customized to your health insurance and the services you selected.”

Step 1. Choose between self pay or insured. Insured patients provide information from their insurance card, including group number and individual number. “One thing that is very nice is that the patient doesn’t have to know what their benefits are or their deductible status,” says John DeZulovich, director of patient financial services.

Step 2: Select service category. For now, patients can obtain estimates for 105 tests and procedures within certain categories, but St. Clair plans to add others in the future, says Richard Chesnos, senior vice president and CFO. “We wanted to start with items that were the most requested by our patients, and the most common, but relatively straightforward so we wouldn’t have to worry about a potential “add-on complexities,” Chesnos says.

Step 3: Choose the specific service. Examples include “71020 - X-Ray Exam of Chest (2 Views-Frontal & Lateral)” and “93271 - EKG 30 Day Event Report” and “Vaginal Delivery (Mother only, baby not included)” and “Newborn (Baby only, mother not included.)”

What Patients See

Patients obtain their plan-specific benefit and deductible information, current as of the date of the estimate. The frequently asked questions section of the patient estimates website includes an explanation of how a patient’s out-of-pocket responsibility is calculated.

  • (Expected insurance payment (allowable) - remaining deductible-copayment) * Coinsurance %= Coinsurance Amount
  • Remaining deductible + copayment + coinsurance amount = amount you owe

When a cursor hovers over a procedure, a box appears to identify the elements that are included in the price estimate. For example, “removal of gallbladder using lap colescystectomy” includes the procedure itself, one medical supply and eight drugs that are included in the estimate.

The out-of-pocket estimates includes “your insurance allowable amount,” “your co-insurance amount,” and “your remaining deductible.” Patients will also see “point of Service discount,” a discount if the estimated payment is paid in full on the service date, and “your cost after discount.” For example, the gallbladder removal estimate would produce the following results.

Patient Estimate Result

What Patients Will See in the Future

The price estimates currently include the patient’s out-of-pocket responsibility only for hospital services, not the physician charges. St. Clair leaders want to change that in future iterations of the tool.

“So we need to get that information onto this same tool, so that patients truly will know what the anesthesiologist will charge, what the surgeon will charge, etc.,” Yeasted says.

St. Clair also intends to provide online estimates for more procedures than the 105 that it started with. However, revenue cycle leaders want to gauge users’ experience with the tool before expanding. “We’ll be gathering that data to see what will be the next refinement of this tool,” Chesnos says.

Getting Started

St. Clair worked with a technology vendor to launch the patient estimate tool. One of its first steps was to ask patients how the online service could work best for them.

Focus group feedback. St. Clair convenes a patient focus group each quarter to obtain feedback about patient experiences with the hospital and solicit suggestions on how to make improvements. “So we took the opportunity to conduct one of these patient focus groups specifically about this product,” Chesnos says.

The focus groups routinely include patients who have received either inpatient or outpatient services during the previous three months. For this topic, individuals were recruited to reflect various insurance types, including Medicare, Medicare Advantage, and commercial insurance.

“We wanted to make sure that we had diversity within the patient focus group, both young and perhaps those who are Medicare age, to provide us with feedback on how to make the tool more convenient for them,” he says.

Chesnos presented screenshots to show focus group members what his team was thinking and get their feedback.

“We wanted to learn: Are we going in the right direction?” DeZulovich says. “So we went through all of the screens and all of the fields to find out whether we could make the information more meaningful to the patients.”

The main takeaway: Patients want the same information they receive in the explanation of benefits (EOB) from their insurance carrier, but they want it in advance of services being rendered. That includes their deductible status, copayment percentage, out-of-pocket maximum, and the amount that will be owed for the planned service.

“One thing we learned is to keep it simple,” Chesnos says. “We (originally) had more information out there but the focus group participants kept going back to what’s on the EOB and ‘what’s it going to cost me personally?’ The rest doesn’t matter to them.”

Chesnos and his colleagues shared other lessons learned from their experience:

Test, test, test. Be prepared to devote considerable staff time to work with the technology vendor. “Imagine testing for multiple procedures for multiple insurance plans multiple times—you can imagine how much time was taken in doing our overall testing,” Chesnos says. “Because one thing we needed to do is to get this right for our patients.”

Educate patients. St. Clair is promoting the online patient estimates by distributing fliers at its outpatient centers and to hospital patients upon discharge. A user’s guide was also developed to help patients understand how to use the tool.

Price TransparencyEmerging

Most health systems are seeking to make out-of-pocket estimates more accurate and easier to obtain for their patients. St. Clair’s online tool improves the patient experience by allowing patients to obtain estimates for common tests and procedures via an online tool at their convenience.

Lola Butcher is a freelance writer and editor based in Missouri.

Interviewed for this article: John M. DeZulovich is director of patient financial services, St. Clair Hospital, Pittsburgh, and a member of HFMA’s Western Pennsylvania Chapter.

Richard C. Chesnos, FHFMA, is senior vice president and CFO, St. Clair Hospital, Pittsburgh, and a member of HFMA’s Western Pennsylvania Chapter.

G. Alan Yeasted, MD, is senior vice president and chief medical officer, St. Clair Hospital, Pittsburgh.

Publication Date: Thursday, May 12, 2016