While the No Surprises Act will be helpful in removing financial barriers from seeking care, it comes with its own set of challenges in creating a fully transparent experience for patients.
At the end of 2020, one of the biggest pieces of health care legislation, the No Surprises Act, was passed. The No Surprises Act aims to protect patients from surprise medical bills, especially in situations where patients have little or no control over who provides their care. This includes non-emergency services provided by out-of-network providers at in-network facilities, emergency services provided by out-of-network providers and facilities, and air ambulance services.
For patients, the No Surprises Act is a timely solution for an issue that has historically been a source of frustration. In fact, a recent Harris Poll found that two-thirds of U.S. adults with private health insurance have received an unexpected medical bill, and of those, one in three were not able to pay the bill with money immediately available to them. Beyond that, nearly half of American adults reported that worrying about the cost of medical bills prevented them from seeking medical care.
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What's more, some patients also reported that their conditions worsened when they did not seek care due to concerns related to out-of-pocket costs. Further emphasizing patients' frustration, Patientco's 2020 State of the Patient Financial Experience Report found that 25% of patients surveyed would rather have their entire wallet stolen rather than receive a surprise medical bill for $500.
The No Surprises Act will benefit the patient experience and ensure greater transparency for patients when it comes to the cost of their care, as well as help rebuild trust and transparency in this country's health care ecosystem. While the law doesn't go into effect until January 1, 2022, there are challenges that lay ahead in ensuring patients can reap the full benefits of this new reform and feel empowered to reach their full health potential.
Reinfusing trust into health care
By promoting access to health care and removing any perceived financial barriers, such as a surprise medical bill, providers can offer more comprehensive care for patients, ensuring positive health outcomes, both physically and mentally. This will ultimately help health care providers build trust with patients and create long-term loyalty. When patients trust their provider, they are more likely to fully realize the benefits of establishing good health care habits, such as going to the doctor regularly whenever a health issue arises and not skipping their annual physical appointments.
health care providers have a unique opportunity right now to continue building trust with patients. As the COVID-19 vaccine becomes more widely available, this is the ideal opportunity for health care providers to nurture trust and re-engage patients to build long-lasting patient and provider relationships. Through personalized and contextualized outreach, providers can continue building trust with patients and address some of the 'unknown' costs of their care.
Alleviating confusion with transparency
While the No Surprises Act will be helpful in removing financial barriers from seeking care, it comes with its own set of challenges in creating a fully transparent experience for patients. It's one thing for hospitals and health systems to be in compliance with the new law, but it's another thing for their patients to actually experience no surprises when it comes to their bills and benefit from absolute price transparency.
This year, the CMS Price Transparency Rule went into effect on January 1 and requires hospitals to publish standard charges. This rule is ushering in a new movement of transparency for health care expenses, which continue to impact individuals' health potential. However, a patient's true out-of-pocket cost is dependent on many factors, including the patient's insurance coverage information, remaining annual deductible, as well as their out-of-pocket maximum.
This new policy is a step in the right direction, but the rule as it stands today, which requires hospitals to list chargemaster prices and negotiated rates, will not necessarily make it easy or intuitive for patients to understand what their out-of-pocket cost will be. Instead, we should infuse technology into the process and surpass the basic compliance requirements of the current Price Transparency Rule.
Achieving meaningful price transparency requires more than a list of shoppable services on a website. Patients need personalized out-of-pocket estimates that inform and prepare. This requires accurate price estimates that patients can engage with and understand. All of this can be supported in a scalable, patient-friendly way with technology. As a result, providers can take some of the guesswork out of seeking care and clearly outline what patients will personally be responsible for at the end of their treatment. Providers must meet patients along their health care financial journey and offer clear details on the financial options available to them.
Empowering patients with financial navigation options
Addressing patients' concerns associated with medical expenses and providing better education about health insurance and how it impacts the patient's out-of-pocket cost is paramount to improving the overall health of the patient. When providers and insurance companies can support education and health care financial literacy, they create a more transparent process that patients will trust.
In addition to greater financial literacy as it relates to health care, the industry must continue to focus on removing financial barriers that prevent patients from seeking care. Patients often perceive their financial situation as an obstacle to getting the care they need. When patients have flexible payment plans or financing options based on their propensity to pay, they will have a more positive health care journey. The more informed patients feel when making choices about their health care needs, the more they will start to trust health systems. And, when we improve the patient's financial experience, our communities benefit and thrive.
Working side by side, health care providers, insurance providers and technology providers can create a future where patients are empowered–not anxious–when they seek care because they have financial clarity when it's time to visit their doctor. The recent reforms with the passing of the No Surprises Act and the implementation of the Price Transparency Rule are steps in the right direction of providing the much-needed transparency and trust that is critical in health care.
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