The following article is written by Jessica Nantz, president and founder of Outpatient Healthcare Strategies.As patient-consumers have assumed more responsibility for the cost of healthcare, they are taking greater interest in where to receive surgical care. Employers have assumed more of the financial burden of the care their employees receive as well, and have also taken a greater interest in where their employees receive care. According to a July 2011 report from the Office of the Actuary in the Centers for Medicare & Medicaid, patient out-of-pocket spending and private health insurance are both projected to grow in 2013. Out-of-pocket spending is projected to grow 3.9 percent in 2013, up from 1.8 percent in 2010. As household incomes grow this is expected to lead to more healthcare spending and employers are anticipated to increase cost-sharing requirements in employer-sponsored insurance plans. Private health insurance spending is projected to grow 4.8 percent in 2013, up from 2.6 percent in 2010. Employer-sponsored insurance enrollment is expected to increase with gains in employment.
While both patient-consumers and employers are looking to keep the costs of care down, they are also seeking providers with a reputation and track record for quality care and positive outcomes to help reduce the need for future care and additional costs.
But the search for providers that can deliver low-cost, high-quality care is no longer limited to a setting located within a reasonable drive. Patient-consumers and employers are surgery shopping outside of their states and regions to identify the best providers available and at the best prices — prices that do not necessarily just look at the cost of treatment but may factor in expenses associated with travel to and from a setting. Payors, looking to keep costs down, are also investing in resources to help their members find quality, affordable care.
With these new developments, spine programs and their partnered surgical facilities (hospital and/or ambulatory surgery centers) are no longer in competition for patient-consumers with just local hospitals, ASCs and other area programs. They are now in competition with providers throughout the country. Due to this increased competition and tightening reimbursement, spine programs must turn themselves and their partnered surgical facilities into destination settings — built around a focus on quality, transparent costs and, perhaps most importantly, superior customer service— if they wish to keep their volume from local patients high and bring in patients from outside of their market.
Here are five steps spine programs should take to turn their organization into a destination setting for surgical care.
1. Provide price transparency. Even just a few years ago, cost wasn't a significant determining factor — if it was a factor at all — of where a patient underwent treatment. For many patient-consumers, price is now a significant factor. You may provide outstanding care, but your spine program may be looked over as an option for patient-consumers if they cannot determine what that care will cost.
As such, it is imperative to find ways to provide transparency into the prices that may be charged for physician professional fee, physician office visit, laboratory, diagnostic testing, surgical facility expense, anesthesia, and any aftercare; explain why you charge the amount you charge; and identify what the charges cover and what they do not. By sharing this information, you are not only providing an important detail that is likely on a patient-consumer's evaluation criteria checklist but you are developing a level of trust with the patient-consumer built around honesty as well as open and accurate communication that does not hide or disguise information.
It is also important to make this information easy to find or patient-consumers may believe you do not provide pricing transparency. For example, if you visit the website of Surgery Center of Oklahoma, an ASC that lists microdiscectomy, lumbar laminectomy and anterior cervical disc fusion as part of its procedures list, the second item on its website's menu concerns pricing. This ASC has received significant, and often very positive, media attention for posting its prices for patients coming to the surgery center for care not covered by insurance.
2. Keep costs low. If a patient-consumer identifies two spine programs believed to provide an equal level of quality care, the lower cost option is likely to win out. While it may go against your organization's model for financial success, continue to explore different ways to lower the cost of the care you provide but now pass some — or more — of these savings along to patients in the form of lower prices.
Employers are not only encouraging but providing their employees with financial incentives to go to lower-cost facilities. As the Los Angeles Times reports, companies like Wal-Mart and Kroger Co. are waiving deductibles, giving substantial bonuses and covering travel and even procedure costs for patients that go to cheaper providers.
So if your efforts to lower the cost incurred by patients brings you more cases, the decline in what you earn per case should be offset; your spine program will be rewarded with more cases at a slightly lower rate, which may be better than fewer cases at a slightly higher rate.
3. Provide quality transparency. It's not just enough to know and be able say your spine program provides high-quality care — patient-consumers need to see the proof to back it up. If your program is accredited, this should be prominently displayed on your website, with an explanation of what accreditation means and what it says about the quality of the care you provide. Patient satisfaction ratings and testimonials, outcomes data and your performance on quality measures should also appear on your website and in marketing materials.
Transparency in quality and cost isn't just important to patient-consumers and employers. Payors are placing a greater emphasis on it as well, and are contracting for services to help their members make educated health decisions based around these components. For example, in late January, insurer Harvard Pilgrim Health Care contracted with Castlight Health to provide 600,000 Harvard Pilgrim plan participants access to insight into cost and quality information for providers and common procedures. Castlight Health is a company built around providing information about healthcare price and quality.
4. Develop and promote travel program. When a patient-consumer from outside your area comes to you for care, they're not just coming to your organization — they're coming to your city, its airport or train station, a nearby hotel and local restaurants. Planning some of these experiences may add stress while others may make traveling for surgery more appealing. If your organization develops a travel program, it can help with both.
Travel programs are designed to assist patients in making the necessary plans to get to your area, ensure they have the means to get to and from your organization for their care and make the time they spend before and after their procedure treatment as stress-free and enjoyable as possible. Travel programs may provide recommendations and discounts on hotels, car rental agencies and restaurants, as well as information on tourist attractions and events taking place during a patient's visit. The members of your organization assigned to the travel program should help address any questions from a patient about their visit and help to make the necessary arrangements and reservations. Facilities may cover some of the costs of a patient's visit to further entice them to select them as their setting for care.
If your organization develops a travel program, you should provide this information on your website, as the Hoag Orthopedic Institute in California does on its website, and in marketing materials. Just the appearance of your travel program may provide a patient-consumer with greater confidence in your organization's ability to help take care of them, not only when they come to your organization's spine program but during their entire visit to your area.
5. Partner with surgery benefit management programs. There are a number of companies designed to help patient-consumers, employers and payors with shopping for providers. These companies, sometimes referred to surgery benefit management programs, assemble a network of preferred facilities, usually based upon a detailed set of criteria.
One such company — Bridge Health Medical — has criteria that includes accreditation by a national agency and demonstration of outcomes and satisfaction scores in the top 25 percent of facilities in the country. If your organization's spine program meets the criteria of a surgery benefit management program and becomes a part of its network, this may further enhance the likelihood of your becoming a destination setting for new patients.
Jessica Nantz (jessica@outpatienthcs.com) is president and founder of Outpatient Healthcare Strategies, a consulting management services firm focusing on operational improvement and efficiencies for ambulatory surgery centers, hospital perioperative services and hospital outpatient departments. The company is based in Houston.
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