Health System Demonstrates Meaningful Price Transparency Is Possible

Baptist Memorial Health Care launched its Expense Navigator tool more than 12 years ago as part of an initiative to improve patients’ financial interactions with the system.

While many health systems still struggle to provide price transparency, Baptist Memorial Health Care, one of the largest systems serving Tennessee, Arkansas, and Mississippi, has been steadily upgrading its online pricing tool for more than a decade.

The Baptist system, which includes 21 hospitals in west Tennessee, Mississippi, and east Arkansas, launched its Expense Navigator more than 12 years ago as part of an initiative to improve patients’ financial interactions with the system, says Bill Griffin, executive vice president and CFO. The initiative’s three goals:

• Self-service online cost estimates
• Online registration
• Bill payment via patient portal

A large team worked more than a year to create the vision for meaningful price transparency and execute that vision. “Over the next several years, we have challenged ourselves by saying ‘This is really good, but we’d like to add this next piece,’” Griffin says. “That’s how we got to where we are now.”

The Expense Navigator includes information for several hundred DRG and CPT codes. Baptist’s goal is to price information for at least 80 percent of all procedures, tests, and medical conditions. The information is reviewed and updated each year by Baptist’s corporate decision support department.

That department, which manages the analytics, statistics, charges, and costs for the health system, recalculates the average charge information and the estimated payment amounts used to make patient liability estimates. “This update process takes some effort because we do it for all of the procedures provided in the Expense Navigator,” Griffin says

When Baptist undertook the effort, no third-party vendors were offering the price-transparency tool that Griffin and his colleagues envisioned so they allocated staff resources to develop it. “You need to go into this realizing that it’s very much a big team effort that’s going to happen,” he says.  

Baptist’s corporate finance department is responsible for the Expense Navigator. The development team included staff from patient access, corporate communications, and information technology as well as the finance department.

Price Transparency, Baptist Style

The “Estimate My Costs” link appears in the upper right-hand corner of Baptist’s home page. Clicking on it takes users to the Expense Navigator, which uses three steps to arrive at patients’ out-of-pocket estimates.

First screen. This screen starts the search process.

• Consumer chooses a hospital from the drop-down list. Prices are available for 15 of Baptist’s 21 affiliated hospitals. Hospitals acquired through a merger last year have not yet been added.
• Consumer selects either “inpatient” or “outpatient” service.
• Consumer selects one of three ways to proceed:
  • Select procedure by name. Choosing this option takes the user to a list of approximately 25 categories, such as “pancreas and gallbladder” and “nervous system,” and a list of available procedures within each category.
  • Input procedure code. This option requires the user to provide a DRG code.
  • Keyword search. The patient can search by keyword or choose from an alphabetized list of common keywords. Choosing “biliary tract,” for example, brings up five procedures or conditions that include that term.

Second screen. This screen shows the average charge for patients’ DRG-specific conditions or procedures. For example, the average charge for inpatient treatment of otitis media/upper respiratory infection with complications (adult) at Baptist Memorial Hospital-Memphis is $21,569. Clicking on the boldface term “average charge” takes the user to a screen that provides brief explanations of various terms via frequently asked questions:

• What is the difference between an “inpatient” and “outpatient” procedure?
• How do you determine the “average charge” of a procedure?
• What is a copayment?
• What is a deductible?
• What does “maximum out-of-pocket” mean?
• What is coinsurance?
• What is a CPT?
• What is a DRG?

This screen also makes it clear that the “average charge” is not the amount the patient will be expected to pay. It asks the question: “Would you like to get an estimate of your out-of-pocket expenses?”

The screen also informs patients that procedures sometimes go hand-in-hand. For example, the screen that reports the average charge for outpatient 3-D bone imaging—$2,649—identifies that five other procedures are commonly performed along with that. For example, a nuclear diagnostic exam—average charge of $579—is performed in 38 percent of cases, while a Tc 99m medronate injection—average charge $39—is performed in 94 percent of cases. 

The patient can indicate which of the additional procedures to include in the out-of-pocket estimate.

Third screen. This screen asks about patients’ insurance statuses. The question “Choose your insurance type” includes three options:

• Medicare
• All other. This is a blended rate that reflects all Baptist’s contracts with commercial health plans.
• None   

Estimates for Insured Patients

Patients covered by Medicare receive explanations of what the estimates include. For an outpatient 3-D bone imaging with a Tc 99m medronate injection, the explanation reads:

If you are insured by Medicare Part B, you must pay an annual deductible before Medicare begins to pay for Part B services. For 2018, the deductible is $183. If you have not met this deductible, you will owe $183 in addition to the copayment listed below. Otherwise you will just owe the copayment. 

Outpatient 2018 Medicare copayment for this procedure = $84

This out of pocket amount is due at the time of registration/admission. 

Choosing “all other” brings up a screen that coaches patients on how to use their insurance information to arrive at accurate out-of-pocket estimates:

Enter your yearly deductible amount. Enter 0 if you do not have a deductible. If you have met your annual deductible or do not have a deductible, enter 0. If you have met part of your deductible, enter the remaining amount.

Enter your copayment amount. Enter 0 if you do not have a copayment.

Enter your coinsurance (percentage) amount. If you are unsure of your coinsurance percentage, please select 20 percent. If you know that you do not have a coinsurance percentage, please select 0.

Enter your out-of-pocket maximum per calendar year. Enter 0 if unlimited.

For a commercially insured patient with a $1,200 deductible remaining and a $50 copayment, the estimate reads: “Your estimated out-of-pocket expenses will be: $995. This out-of-pocket amount is due at the time of registration/admission.”

Estimates for Uninsured Patients

If patients indicate they have no insurance, the next screen links to the health system’s charity/uninsured/indigent policy and a link to download a copy of the financial evaluation form.

It also provides patients’ out-of-pocket estimates based on the hospital-specific self-pay minimum discount according to the IRS 501(r) charity requirements, Griffin says.  

For example, the minimum discount rate for Baptist Memorial Hospital-Calhoun in Calhoun City is 52 percent while the rate at Baptist Memphis is 74 percent. So even though the average charge for an MRI of the brain with dye is $1,564 at the Calhoun City facility and $3,105 at the Memphis flagship hospital, the out-of-pocket responsibility for a self-pay patient is $845 in Calhoun City—compared to $747 in Memphis.

A Useful Resource

While the Expense Navigator was developed as a self-service price transparency tool for patients, it doubles as a staff resource. When scheduling or registering patients, staff members use the tool to inform patients of their expected out-of-pocket costs and to pursue up-front collections.

“If I’m registering someone on the phone, I can say ‘It looks like your estimated out-of-pocket is going to be about $250. How would you like to pay for that?’” Griffin says. “Or ‘When you come in for the procedure, would you remember to bring your credit card or checkbook?”

A Pioneer in Price Transparency Tools

As price transparency has gained attention over the years, including a recent government mandate to post hospital charges online, Baptist Memorial Health Care’s 12 years of experience with a price transparency tool can be an inspiration to hospitals and health systems just starting development plans. Whether building a tool internally as Baptist did, or working with an outside vendor, for hospitals and health systems, working toward price transparency is an idea that is here to stay.

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

Interviewed for this article:

Bill Griffin, FHFMA, is executive vice president and CFO, Baptist Memorial Health Care, Memphis.