Less than ideal, but what about listing cash pay prices w a disclaimer about calling for specific patient responsibilities based on different coverage models, and then linking to a chat window like we see on some consumer sites, lowering the barrier to immediate feedback on the information? I heard recently that some insurers are actively reaching out to their patients who are scheduling/pre authorizing an MRI for example and giving them a list of locations along w the pricing at those locations. They might be willing to help resource such a thing for their insured as it would be in their interest to increase insured awareness, but that does introduce some risk that they redirect away from our facilities. Wonder if possible to do some integration w their sites for specific procedures’ pricing.
The meds alternatives functionality from Epic is a step in this direction w meds though there are limitations currently as it can only program one payer plan across all patients.
Lisa, is there much prevalence of urgent care facilities w extended hours? Perhaps the issue is more w uncertainty about how to navigate the system or the hours of access? Do EDs offer a fast track arm? Is there any opportunity without violating EMTALA to provide a navigational point, a sort of triage before ED triage, that can direct patients to adjoining urgent care facilities for lower acuity issues? It’s not the same as shunting them to primary care access channels but the immediate access of the ED may be too stark a contrast to our traditional primary care access channels to be able to successfully redirect without lowering the threshold to entry.
There are always those more influential and respected members in any group of providers – it would be useful if at all possible to engage those providers in this initiative and pursue it as a pilot of sorts. It may be difficult if not impossible to convince anyone to completely relinquish their existing model when they have no burning platform and there would be uncertainty about the gains, unless really it can be structured as all upside–access to additional services and supports without impinging on existing practices. Even then a potential change in locale would be a difficult sale, but I wonder if it can get off the ground by providing a part-time or rotational model?
Well, Internet died and lost my response which was surely the answer to all your problems. =). Anyway, I’m unclear whether the problem is that the software is unable to handle the differing charges or if the goal is more one of management, trying to reduce variation for the purposes of managing operations and planning. Unclear what is behind the payer denials or if it is arbitrary?
It would seem that would need revenue steering committee w representation across the hospitals focusing on one group of CPTs/bundles at a time to try and gain alignment and then bring in payer representation, though w so many private payers that will prove to be a slow and challenging road..
Acknowledge directly the challenges org is facing rather than normalizing. Take ownership for lighting a path forward by example, accepting my role in healing and setting example. Work to inspire belief that can be part of something better and that input is valued, foster shared pride in what can achieve that will benefit us all.