Clinicians’ Corner with PwC principal Kathryn Burg Plaza

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February 14, 2020

In this occasional series, HRI talks with PwC leaders who are also clinicians. Kathryn Burg Plaza brings extensive clinical patient care experience to the firm. She is a nurse practitioner with clinical and leadership experience at academic medical centers.

PwC Health Research Institute (HRI):

With recent actions by CMS to force the industry toward price transparency, how does this issue impact the daily interactions between clinicians and their patients? 

Kathryn Burg Plaza, PwC Principal and Clinician:

This issue pushes clinicians to pay attention to prices in a way they never have before. Patients now often have high-deductible plans, so they are concerned about the costs of their clinical services.

In the past, clinicians were judged on patient satisfaction, clinical acumen, their affability, and care for the patient and their families. Now there are new pressures associated with patient “financial” satisfaction.

The new requirements are creating an element of patient shopping for clinical care. In the rules that have come out from CMS, hospitals are required to list what they’re calling “shoppable services” with patient-friendly descriptions so it’s easy for patients to compare and contrast the cost of an X-ray or a lab test.

In the past, patients only understood the charge of services when the bill was received. Now patients are often armed with this information before they see their provider. This provides them with the opportunity to share questions and concerns with the clinician or provider during their encounter.

That requires the clinician to have at least enough knowledge to answer those questions at a basic level and get through their encounter while maintaining the patients’ trust and confidence in their care. With this in mind, hospitals need to work on collaborating with the clinical teams so they do have enough information to answer questions during patient encounters and know how to refer patients to appropriate financial counseling.

HRI: What could this price transparency push mean for healthcare organizations overall? And what should they do now to prepare?

Kathryn Burg Plaza: One of the big things we’re seeing is an enhanced awareness for health systems of how their prices compare with competitors’—locally, regionally or with peers.

A lot of work is being done around price comparison and benchmarking analytics, and with those results, there is an effort to adjust prices to be reasonable, especially with the notion of shoppable services. That’s not always a simple task, because of the way managed care pricing is established.

Adjusting a charge on a given item that has a high volume may have a significant net revenue impact to the healthcare system. When price comparisons and adjustments are established, you have to figure out a way to manage the revenue implications of those changes while staying competitive in the market.

The other piece that is happening in our industry right now is there has been a surge of deals and healthcare system expansions. That means there could be various charge description master files, which is a file used to maintain their prices.

As they begin to consolidate pricing so they can manage their charges and what is now required to be posted publicly in a more efficient way, they also have to think about pricing across a system, which can be very challenging. In one health system, they can have large academic medical centers as well as community hospitals.

This also links into the need for patient charge estimates prior to their hospital visit or physician encounter. A lot of work is being done to enhance the digital interaction (including apps as an example) prior to a patient visit so they can have the price estimate upfront to see if they need to set up payment plans.

HRI: What are clinician concerns around this drive toward increased price transparency? 

Kathryn Burg Plaza: The first is maintaining patient volumes. Are clinicians going to lose patients purely based on cost of care? I don’t think that’s ever been a factor before in worrying about referral patterns, patient satisfaction or providing high-quality outcomes—those were the typical levers in the past that kept patients within a provider practice or healthcare system. Now there is this new influence on where patients choose to have care.

The patient satisfaction element is significant. Patients could be dissatisfied about their entire patient encounter because of their bill and go online, talk about it, give bad reviews. This is an era of consumerism that we have not experienced in this industry.

One other big change is that the hospitals have to publish the payer rates for services that they’re providing. That’s always been a mystery. I have this charge, what is this payer covering? All of that detail will have to be published.

We would see that also influencing the patient-payer relationship. They will have a lot more questions about their responsibility and what the payer is covering. I don’t know if that will come back to clinicians or not, but it’s new and may create more questions.

HRI: Our Top health industry issues of 2020 report identifies consumer finance as a patient experience opportunity. How can organizations improve patient experience around billing and payment? 

Kathryn Burg Plaza: Health systems are looking at ways to consolidate the patient bills—one bill for the professional and hospital services, not multiple, which has caused patients confusion for decades.

Health systems also are looking to enhance the patient experience by improving digital access, enhancing cost estimates upfront, being able to have consumer-friendly descriptions of services so patients can find what they need online in an easy manner to keep patients within the health system, and give them accessibility to what they need to make a decision.

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Trine K. Tsouderos

HRI Regulatory Center Leader, PwC US

Tel: +1 (312) 241 3824

Crystal Yednak

Senior Manager, Health Research Institute, PwC US

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