Billing Quality Is Medical Quality

“Given the wide variation in both pricing and collection practices by hospitals, measures of billing practices are needed. Billing quality is a type of medical quality. In the same way that medical complication rates are collected for improvement purposes and some are available to the public, metrics of billing quality could be used to create public accountability for US hospitals.

[..] The first proposed metric is whether patients are routinely provided with an itemized bill of services in plain English. Most bills have historically listed medical codes and terms. However, describing services in a way that is understandable to patients is an important step toward patient-centered billing.

The second metric queries if prices for elective services are made available for patients who ask. Some US medical centers, such as St Thomas Hospital in Nashville, provide prices for common medical services on third-party online consumer marketplaces. In a preliminary study involving 6 ambulatory surgery centers that publicly list prices for surgical services online, 5 centers reported that this form of transparency resulted in higher patient satisfaction.

The third metric suggests that patients should have the right to speak promptly with an appropriate person about their bill, so that errors can be corrected and potential accommodations can be provided in the form of delayed or markedly discounted payment options or complete debt forgiveness.

The fourth metric addresses whether the health care institution sues patients for unpaid medical bills. This practice violates the historic mission of hospitals to be a safe refuge for individuals with illness or injuries, caring for all regardless of their ability to pay. Caring for people at a time when they are most vulnerable represents the best of the medical profession, but suing them to garnish wages represents a potentially harmful characteristic of modern health care.

The fifth metric addresses the double standard of expecting that patients who pay medical bills out of pocket should pay much more than others for the same care. High chargemaster prices have historically been inflated for the purposes of offering discounts to different insurance companies, yet self-pay patients have increasingly encountered these inflated prices.

The fifth metric also asks if patients are directly charged for complications that resulted from a serious reportable adverse event, such as a surgical never event (for example, wrong-side surgery or operation to remove a retained foreign body).

[..] The financial harm of medical care should not be separated from the clinical consequences of care, because both outcomes can have a major influence on the health and well-being of patients. Financial harms also may affect access to care.”

Full article, Mathews SC and Makary MA. JAMA 2020.2.4