Bill Transparency: Lessons Learned South of the Border

I was in Mexico recently on vacation. As my husband and I rode the public bus into Cancun city, we heard a sad tale.

A man from Cozumel stood at the front of the bus and told us about his daughter who was gravely ill, suffering from hydrocephalus or "water on the brain." The equipment needed to help treat the ailment and keep the 13-year-old alive was only available at one hospital in this part of Mexico, a naval base in Cancun.

As any parent would do, the adolescent's father—a bus driver himself—moved from Cozumel to Cancun to get treatment for his daughter. Upon arriving, he learned that it would cost him $2,800 per week for the treatment, not including surgery.

Now, my husband speculates that this gentleman may have inflated the number to add "umph" to the story, but as there was no way for me to verify it, I will go with it. Even if the number is inflated, in a country where the peso to U.S. dollar is approximately 12:1 and the average worker earns 57 peso per day with no health insurance, a price tag like that is devastating.

The tale got me thinking about how hospitals in the U.S. share costs with their patients—or don't share until after the fact, which is more often the case. And that's interesting, when you really ponder it.

I speak to a lot of financial leaders as well as their bosses, and they are all concerned about the rising numbers they see in uncompensated care and self-pay patients coming into their facility. The latter are perhaps of bigger concern because they are the unknown—many of them have the potential to become a loss on their bottom line.

It's the self-pay patients that actually remind me of this Mexican father. Today in America so many of our friends and colleagues are out of work and those who are fortunate enough to have jobs have higher deductible health insurance plans. Two-income families are now single-income and everyone's wallets are feeling the crunch. Folks are trying to be prudent with their dollars—sticking to budgets and weighing the costs of everything from a pack of gum to getting their car serviced.

Yet, if a family member gets sick, they have no idea how much care will cost. How much is a primary care visit? How much is treatment for a sprained ankle in the ER? It seems few hospitals are able to say, or even approximate.

It's annoying to the patients, but to me it seems contrary to one of the key goals facilities are striving for: to be more patient friendly.

Patients have been calling for bill transparency for years, yet most U.S. facilities don't answer the call. Moreover, many facilities opt to bill patients after treatment and don't offer patients so much as an estimate of what their services will cost.

It makes little sense why in this technological age, every single U.S. hospital cannot print out an estimate of cost on, at the very least, their most frequently used services. Certainly, after years of doing business, facilities have an idea of how much it costs to have a gallbladder operation or to set a cast.

With a tentative diagnosis, a hospital billing department should be able to offer some general billing information to the patient in advance. Perhaps even two estimates—a best and worst case scenario set of bills. It seems preposterous to me that I can get an estimate from my veterinarian for my dog's surgery, but not one from the hospital up the street for my own.

As a healthcare writer, I know more than the average patient and yet I'm frequently left dumbfounded by these seemingly simple actions that could be taken to make patients' lives easier and invariably give hospitals a better upfront chance to recoup payment for treatment.

I have consistently found that it is the hospitals that immediately offer me an excuse as to why they cannot provide an estimated bill for a patient that are also often the ones who are financially struggling. They immediately point to the cost and manpower required to provide such a bill and then throw their hands in the air and say, "We can't do it; it wouldn't be accurate. We don't have the money to set this up and our technology isn't there yet."

Well perhaps if you can't come up with the money, or innovation, to get it done, then your patients shouldn't have to come up with the money either. Which is what is already happening—the patients aren't coming up with the money and your uncompensated care costs are rising.

Estimates are by their nature educated guesses and with a bit of effort a series of spreadsheets can provide enough data to make these estimates a reality. If a naval hospital in Mexico can estimate a hospital bill, certainly all of the hospitals in the United States can do the same.

We are in a serious recession and even when this cloud passes, the climate will never be the same for any industry, including healthcare. Some say it is the lack of innovation and our sense of entitlement that got us into this recession in the first place. I agree. Solutions don't have to be expensive and the latest technology may be the best answer, but it isn't the only one. It's time to innovate.