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Case Study | Self-Payment Collection

Colorado Health System Increases Price Transparency for Self-Pay Patients

Case Study | Self-Payment Collection

Colorado Health System Increases Price Transparency for Self-Pay Patients

SCL Health shows self-pay prices in two ways—an average for a specific service and the range of prices charged in the past year. This helps set realistic expectations when prices are above average based on varying factors.

Denver-based SCL Health says it is not yet clear that many self-pay patients are using pricing information. But it is a step toward the kind of transparency that will eventually help patients make decisions by comparing providers based on quality and cost.

Six months into a state-mandated price transparency initiative in Colorado, leaders at Denver-based SCL Health see no evidence that many self-pay patients are using the information. Nonetheless, they think the public posting of prices is a move in the right direction.

“We believe promoting and supporting transparency in pricing and also clinical quality is the right thing to do,” says Christine Woolsey, the system’s senior vice president and chief communications and marketing officer. “The fact that consumers are paying more out of their pockets because of high-deductible plans and copays means we have to do what we can to make it easier for them to understand costs and their choices.”

SCL Health is a $2.6 billion regional health system serving Colorado and Montana, and it operates safety-net clinics in Kansas. Like all providers in Colorado, it is subject to the state’s Transparency in Direct Pay Health Care Prices Act, which went into effect Jan. 1. The law requires health facilities to publish online the self-pay prices of their 50 most-used DRG codes and the 25 most-used CPT codes. 

See related sidebar: Self-Pay Transparency in Colorado

Although it is not mandated to do so, SCL Health also posts emergency department level-of-care prices, as recommended by the Colorado Hospital Association.

What Prices are Posted

The law requires health facilities to disclose self-pay prices for the previous 12 months, but it gives them leeway in determining how the posted prices will be determined. 

SCL Health chose to post prices for inpatient procedures in two ways: average and range. For example, the average price for DRG code 291—heart failure with major complications—is listed as $12,548 and the range is $7,984 to $17,825.

“We did a range because there is so much variability and we did an average so folks would have both of those data points,” Woolsey says. “All of these prices can vary greatly depending on the medical needs of the patient and other services that they are prescribed.”   

For outpatient procedures, doctor visits, and emergency department (ED) visits, a single price is posted.

How Price Information is Presented

The Colorado law requires the self-pay prices to be published online. SCL Health facilities engaged their patient and family advisory councils to seek input on how best to present the data—and learned that patients want more.

“We received feedback that people like to call,” Woolsey says. “They may start out online but they want to be able to talk as well so we made sure those pricing pages include a phone number so they can talk to someone live.”

Each pricing page includes an explanation of what is—and is not—included in the posted prices.

The inpatient pricing page includes these statements:

  • All costs are estimates and your specific costs may vary from these estimates depending on the specific services you receive.
  • We provide self-pay patient discounts for those patients without insurance, and those discounts have been applied to the costs below. 
  • Note: The prices below are for patients that do not have insurance. The hospital fees for lab tests, procedures, and diagnostic tests are included. Physician fees and fees for physicians to read x-rays, pathology tests, etc., are not included in the costs listed.

Meanwhile, the ED pricing page includes these statements:

  • These are ED level of care charges for patients that do not have insurance. Lab tests, medications, procedures, physician charges, and diagnostic tests are not included in the emergency level charge.   
  • You will receive multiple bills for your ED visit. 
  • Most people will receive additional charges from SCL Health on their hospital bill for an ED visit. These may be for lab work, x-rays or other imaging, medications, and other necessary treatments, procedures, or supplies.
  • You will also receive separate bills from physicians involved in your care at an SCL Health hospital. You will receive a bill from the ED physician and may also receive bills from other providers, such as a radiologist, for the reading of an x-ray or other imaging services.

Consumer Response

A review of SCL Health’s web traffic suggests that the price information is not getting much attention from consumers so far. 

During the period from Oct. 31, 2017, to May 22, 2018—which includes two months before prices were posted and nearly five months after—the webpage titled “Understanding Medical Costs” had approximately 2,600 page views. That accounts for just 0.08 percent of the 3.5 million total page views of the SCL Health website during that period, Woolsey says.

“That data would indicate that there is not robust use of this information at this time,” she says.

The price transparency page had 948 sessions, compared to 1.3 million total sessions for the health system’s website overall, during the period. Woolsey suspects that some of those sessions were by insurance brokers, competitors, and reporters rather than consumers, although data is not available to know for sure.

Tips from The Front Lines

Complying with Colorado’s price transparency has not been difficult, Woolsey says, although it is not yet clear that many self-pay patients are using the information.  

Some of the prices posted are not particularly useful; knowing that the average price charged to self-pay patients for heart failure with major complications in the past 12 months was $12,548, while the range was $7,984 to $17,825, is not information a patient can work with. 

But it is a step toward the kind of transparency that will eventually help patients make decisions by comparing providers on quality and cost. “The challenge is for the industry to continue to find ways to make the purchasing of health care more understandable and less complex to a consumer,” Woolsey says. 

The first step to increasing price transparency is to embrace the trend and be proactive. “Once you make the philosophical decision that it is the right thing to do—and hopefully most of our peers have done that—it makes it easier to tactically go about providing better transparency,” she says.

Other advice:

Don’t wait for legislators to take the lead. Organizations that are committed to helping patients learn about healthcare costs will find ways to do so. “There are steps providers can take now to embolden patients to make better decisions,” she says.

Seek input from patients. Ask your Patient Advisory Council what information they want, how they might use the information, and how they want to receive it. 

“That’s really been helpful for us in terms of how we designed the webpages and the language we used to make sure it was consumer-friendly and not jargon that we use in the industry,” she says.

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

Interviewed for this article:

Christine Woolsey is senior vice president and chief communications and marketing officer, SCL Health, Denver.

About the Author

Lola Butcher

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