Large consumer survey finds that patients link billing experience to perception of care quality

In a national online survey of healthcare consumers, two thirds reported consistently being surprised by medical bills despite the fact that nearly all desired upfront cost estimates and valued these nearly as much as other clinical factors in their decision making, including outstanding bedside manner, prompt test results and accurate diagnoses.

While the desire for price transparency is nothing new, the strength of this consumer demand for price transparency in the survey was notable. Among the survey respondents, more than eight in 10 (84 percent) said that front-end cost estimates would have either a somewhat positive (37 percent) or very positive impact (47 percent) on their decision to continue using a provider. Those who’d had positive billing and payment experiences with their healthcare provider also gave high ratings to their quality of care over the past year. Conversely nearly all patients who’d had poor billing and payment experiences rated their quality of care as poor.

Revenue cycle software developer TransUnion Healthcare, a subsidiary of the Chicago-based credit and information management company TransUnion, conducted by the survey between May 1 and June 1, and collected responses from 7,407 people who were a primary medical decision-maker in their households and who had either personally received medical care, or had a family member on their policy receive care in the past two years. Respondents came from all 50 states and were broken down by insurance type (employer-sponsored health insurance, individual health plan, Medicare, Medicaid or VA/military health plan) in percentages that roughly mirrored those of the 2012 U.S. census. This was their third year conducting the survey.

The finding that medical cost transparency and billing accuracy correlates with patients’ perception of the quality of their care was also found in previous surveys noted Dave Wojczynski, senior vice president of TransUnion Healthcare, in a press release. This means that while measuring direct return on investment in creating price transparency is difficult, there almost certainly is one and providers who ignore consumer demand for upfront pricing, accurate billing, clarity and overall cost transparency may lose business and reimbursement as value-based payment systems with a patient satisfaction element take over for traditional fee for service.

"Front-end solutions that provide upfront cost estimates, and back-end solutions that deliver accurate bills, will be critical as consumers continue to link their billing experience to quality of care,” Wojczynski stated. “Accurate, timely and transparent cost information will help improve overall patient satisfaction and will increase return visits to providers."  

The survey also found that legislative efforts to force healthcare cost transparency make little difference in the consumer’s experience. Patients in Colorado, Maine, Massachusetts, Vermont, and Virginia — the five states that have passed laws aimed at helping patients get more up-front information about healthcare costs — were no more likely than those in other states to have asked for or received front-end cost estimates.

Patient experiences differed more by whether they were in a small or large population state. Patients in large states reported having better billing experiences and more access to upfront pricing information than patients in small states. They were also somewhat less concerned about healthcare costs. The patients most likely to say they were increasingly concerned about healthcare costs were residents of small western states. In addition, patients residing in states with a population in the bottom third of the 50 states, were twice as likely to report a poor billing and payment experience than those in the larger states.

To aid healthcare providers, the Healthcare Financial Management Association (HFMA) announced at its annual meeting this week that it has added to it resources on cost transparency. The new section is called Dollars and Sense and can be accessed through its website.