Open Data Platform Simplifies Payment Estimates

With laws such as the “No Surprises Act,” government has thrown its considerable weight behind the pressure on payers and clinicians to give patients good-faith estimates of the total cost of treatment. According to Marcus Dorstel, VP of Operations at Turquoise Health, both payers and providers have struggled and invested large amounts of effort in meeting the new requirements. Payers and providers who want to meet the intent of the law by adding up or “bundling” the many parts of treatment offer “service packages” that estimate what a patient will pay. These service packages get very detailed, because the institution has to consider many factors. What precise procedures are used for a common problem like knee replacement? Will the patient have to stay overnight? What pre-op and post-op care is required? The payers and clinicians are accepting some risk in providing these packages, because patients deviate from expected courses of treatment. There is an actuarial element to the calculations, assuming that some patients will exceed the expected cost and some will cost less. For instance, the clinicians might estimate that a certain action must be performed 80% of the time to complete a procedure; in such a case, they can include 80% of that cost in that service package. Because contracts are typically updated annually, each package must be prepared for changes in the environment and patient population during the contract period. The calculat...
Source: EMR and HIPAA - Category: Information Technology Authors: Tags: Administration Ambulatory Analytics/Big Data Communication and Patient Experience Health IT Company Healthcare IT Hospital - Health System LTPAC Regulations Bundling Healthcare Bundles Healthcare Price Transparency Healthcare Prici Source Type: blogs