Providers push for medical billing quality metrics to root out laggards

Radiology and hospital billing practices can profoundly impact patient outcomes, and yet there are no quality metrics to gauge this aspect of the care process.

A duo of doctors from Johns Hopkins University’s School of Medicine, however, believe it’s long past time to address this issue in a scientific manner. They’re advocating for the establishment of five quality metrics to rank medicine’s best in delivering the final IOU for healthcare services. Measurements could gauge whether a radiologist itemizes a final bill, or sues patients to collect unpaid debts, authors argued in a Feb. 4 JAMA viewpoint.

As an example of one leader in the field, the authors cited Tennessee-based St. Thomas Hospital, which provides upfront pricing for its own radiology services. Costs range from $74 for basic chest imaging up to $595 for an x-ray with arthrogram, according to its website. On the flipside, Simon Mathews and Martin Makary noted a 2016 study, which found that only half of hospitals state standard pricing for coronary artery bypass graft surgery. Those that did, however, charged anywhere from $44,000 to $448,000 for the procedure.

“Given the wide variation in both pricing and collection practices by hospitals, measures of billing practices are needed,” the authors wrote. “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 U.S. hospitals.”

Mathews and Makary offered five possible quality metrics to get the conversation started:

  1. Itemized billing: Are patients routinely given a detailed bill with items explained clearly?
  2. Price transparency: Are patients provided real prices for common shoppable services?
  3. Service quality: Can patients speak with a billing representative promptly about their concerns?
  4. Suing patients: Does the provider pursue litigation against its patients to collect unpaid funds?
  5. Surprise bills: Are out-of-network patients charged more than their counterparts?

The authors noted the real harm these practices can cause, with one survey finding 64% of patients delayed or neglected medical care in the previous year due to cost concerns. Healthcare measurement organizations, such as CMS and the Leapfrog, need to take a serious look at this topic to begin moving the needle, they concluded.

“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,” they wrote.