New Consumer Guide to Healthcare Pricing Published

By Rodney J. Moore, MDalert.com contributing writer.

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  • The guide emphasizes performance-based healthcare – teaching patients how to get the best outcomes at the lowest costs.
  • Consumers are increasingly paying 100% of claims.
  • New guide enables patients to comparison shop among treatment providers.
  • Consumers will encounter more opportunities to choose care providers.
  • Healthcare consumers will face steep learning curve as volume of market information increases.


The Healthcare Financial Management Association (HFMA) has published an updated version of its consumer guide to healthcare prices. The 2015 edition of Understanding Healthcare Prices: A Consumer Guide includes a new section designed to help consumers assess healthcare quality.

“We felt that is was really necessary to help patients navigate the quality world because there are a number of different sources they can go to,” said Jim Landman, Director of Policy, Perspectives, and Analysis for the HFMA.

In addition to providing valuable information covering Medicare and insurance exchange protocols, the guide offers a step-by-step process for consumers to obtain price estimates. One particular highlight is a detailed explanation of in-network and out-of-network care with a breakdown of actual costs in action.

Performance-Based Healthcare:
Improved Outcomes, Decreased Cost

The guide emphasizes value in healthcare and aims to show patients how to achieve the best outcomes at the lowest costs, the essence of performance-based healthcare.

The guide is also designed for consumers who wish to comparison shop or to better manage their out-of-pocket expenses. In addition to several pages of helpful pricing information, the guide also includes a three-page glossary of definitions.

Joe Fifer, HFMA President and CEO said the future of healthcare almost demands that providers take a more proactive role in patient education.

“In almost every scenario that we can envision, consumers will have a significant play in making their health care decisions,” said Mr. Fifer. “Quite frankly, our industry hasn't been great at this over the past generation,” he said. “But I think you're going to see more and more information being made easier and easier to understand for consumers.”

“The consumer, in many cases, is paying a higher and higher percentage, if not one hundred percent of claims,” said Mr. Fifer. “They're experiencing that now and they're paying much more, or much closer attention to both the finance and the quality data to make those value judgments. I think it's absolutely huge for physician practices.”

Better educated patients will be better consumers of healthcare services. Performance-based healthcare puts patients in physicians in positions to control costs while improving outcomes.

 

Sample Entries from the Guide

Where to find information about quality guidelines

▶The federal Agency for Healthcare Research and Quality has produced summaries for patients that tell about effective health treatments for selected conditions (http://effectivehealthcare.ahrq.gov).  These summaries are based on expert reviews of medical research.

▶Cochrane Collaboration is an international not-for-profit and independent organization that reviews medical research studies about healthcare treatments. The website www.cochrane.org has easy-to- understand, plain-language summaries of the findings of reviews in the Cochrane Library.

▶A government website (www.guideline.gov) with technical medical information for health professionals includes some links to resources that are written for patients. Click on Guideline Resources and then click on Patient Education Materials.


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