EPtalk by Dr. Jayne 1/28/21

In response to my recent piece about hospital price transparency, Jenn clued me in about Turquoise Health and their pricing website. It’s still in beta and doesn’t have data for my area yet, but comparisons for a neighboring state were pretty easy to understand. It looks like they’re still building their insurance rate database, but their cash-pay display was clear.

A reader also sent some thoughts about the whole transparency situation. He notes that based on some vendor-side experiences, a large number of hospitals seem to be deliberately dragging their feet and don’t want to be the first in their market to show what’s behind the curtain. Either that, or they’re not able to meet all the requirements since many of them assumed that the rule would be killed or further delayed. He notes, “Many will presumably quietly delay until HHS starts embarrassing some folks with bad PR and the compliance / penalty process.”

He goes further to note that the online tool I mentioned in my piece isn’t compliant, since “the Rule requires that a consumer be able to access the pricing info for all contracted payers WITHOUT providing any identifying information or agreeing to anything.” He agrees that third-party aggregators (presumably like Turquoise Health above) will take the machine-readable files and create the equivalent of “Travelocity for Hospital Prices.” I think that’s going to be the best approach that will benefit consumers from an experience perspective, but agree with him that the behind-the-scenes benefit will be when plans and networks and benefits brokers can see the information and use it to drive pricing negotiations.

My reader predicts that price transparency will ultimately lead to hospital closures, as hospitals will no longer be able to “cross-subsidize underfunded services with high commercial rates.” I always love hearing from readers and understanding what’s going on in different parts of the country and this was a great discussion. Rather than watching hospitals close, I’m hoping that health systems will take this as a wakeup call and begin to help lobby for better public health infrastructure and more public funding for early prevention, screening, and treatments so that we can push back against the chronic diseases that are driving healthcare expenditures.

Unfortunately, that approach will erode the profits of hospitals and payers, and some people feel it smacks of “socialism” and we’ll see politics and economics forcing public health into the back seat again and again despite the fact that strong public health measures make good economic sense long-term. The resignations of public health officials across the country due to their COVID-fighting stances has been disheartening. I hope we’ve seen as much of that as we’re going to see for a while. I’ve enjoyed seeing Dr. Anthony Fauci smile again this week, though, so I’ll stay hopeful.

I had another round of healthcare adventures with Big Health System this week. The first was for a physician appointment with their academic faculty dermatology practice. I received my appointment reminder in Epic and completed the online check-in process, which was seamless. I was surprised that they’re not doing any virtual waiting room strategies and that I had to physically come to the office to check in and sit in the waiting room, which is very different than what my practice does. At least the wait was brief and I was impressed by the documentation of the cleaning protocol that was posted on the exam room door. Since this was a dermatology practice, they also had signage explaining how they do a full skin exam in the time of COVID and to keep my mask on — the physician would tell me when to take my mask off and reminded me not to talk when my mask was off.

The second encounter was an unsatisfactory pre-registration phone call prior to an upcoming MRI. Apparently, my data in the system journeyed through a portal to another time and reverted to values from 2018. I just had another radiology study at the same facility less than five months ago, when I updated everything on a lovely paper form that I assume would have been uploaded. Somehow today they had my employer from 2018 listed and the wrong emergency contact. Having been in the CMIO trenches there, I asked what system the registration agent was working from, since they still use another system for some financials and Epic for clinical. She said she was working in both systems, but the data in question was not in Epic. Apparently, they  don’t have a bidirectional interface, or no one updated the information provided back in August, or both, so I got to do it all over again over the phone with someone who wasn’t that interested in my responses and wasn’t really paying attention.

She also went through the same COVID screening questions I had just answered an hour earlier, and I asked her to verify that I was flagged in Epic as an emergency doc since this was an issue during some previous visits. She actually admitted that she really didn’t look at the screen because she’s just so used to asking the same questions over and over. When I clarified that yes, I’m regularly exposed to COVID in my work, she replied, “So, you currently have COVID?” and I had to explain again. Here’s hoping she was actually doing what she said she was doing and updating their revenue cycle platform rather than just going through the motions, because I don’t want to have to update everything again at my radiology visit at the crack of dawn on Friday. These were the kinds of issues I enjoyed fixing when I worked there – making the patient experience seamless. I wonder if anyone there even knows it’s messed up, and if they do, whether they really care.

I’m not exactly looking forward to having my molecules magnetically spun, but it is what it is when you’re playing the early cancer detection game. Usually I schedule the test first thing in the morning when I’m tired so I can sleep through it, which the technicians find hilarious since “no one ever sleeps through an MRI due to the noise.” Maybe they just don’t scan enough sleep-deprived urgent care docs to have a good sample size. I figure the first appointment of the day is also good for COVID-prevention purposes.

What’s your strategy for being a patient in the time of COVID? Leave a comment or email me.

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