One of the biggest worries of patients going into the hospital is how much it’s going to cost them.

UCHealth has created a new price estimator tool that not only includes the price of the procedure but also connects in real time to the patient’s insurance company and estimates the amount the patient will pay out of pocket.

UCHealth’s tool “is innovative and may be the first of its kind in Colorado and potentially nationally,” said Julie Lonborg, vice president for communications and media relations at the Colorado Hospital Association.

“Hospitals have had pricing tools that give patients a range of what a procedure might cost, but they were not specific to their insurance, copays and deductibles,” Lonborg said. “What’s unique about UCHealth’s tool is its ability to be personal to individual patients.”

The tool is available both online and through a mobile app, said Dan Weaver, senior director of PR & Communications for UCHealth.

How it works

Accurate estimates have been difficult for hospitals to provide because an individual’s out-of-pocket expenses depend on the insurance plan and how much of the deductible and out-of-pocket maximum has already been reached.

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UCHealth’s tool, which is available to patients at UCHealth Memorial Hospital Central and Memorial Hospital North in the Colorado Springs area, takes those factors into consideration.

To use the tool, a patient must sign in to My Health Connection, UCHealth’s patient portal, or download the UCHealth mobile app.

My Health Connection also allows patients to email their doctor, schedule or request appointments, view test results, refill prescriptions, request medical records and pay bills, and the mobile app enables virtual visits with providers in some situations.

price estimating tool health careOnce enrolled in and logged onto My Health Connection, a patient can select a service category, such as heart and vascular care or surgical care, and then a specific service.

For current patients, the tool already contains insurance information. New patients or those who recently changed insurers will need to input their information.

The estimator tool will connect with the insurance provider to verify plan details and identify how much of the deductible and out-of-pocket maximum have been met during the current plan year.

Patients then choose the UCHealth location they wish to visit and receive an estimate that is specific to their insurance plan and deductible. The tool deducts the insurance payment to show the estimated amount the patient will pay.

What isn’t included

The estimate does not include professional fees at this time.

“Some time next year, we will be able to provide both facility costs and physician costs if the patient is seeing a UCHealth doctor,” Weaver said.

The tool won’t factor in fees of providers who are not contracted with UCHealth. But Weaver said patients can reach out to external medical groups or physicians to get estimates of those costs.

“The best way might be to connect with their insurance company, which might be able to give those estimates,” he said.

The tool contains pricing information on about 150 services now, and “we’re adding more services on a weekly basis,” Weaver said. “We picked the most commonly requested estimates to build out first.”

The tool also can’t take into account additional services a patient may require during the hospital stay.

“For the services listed, the tool is very accurate and very inclusive of those costs and potential responsibility for the UCHealth bill,” Weaver said. “It is always possible that each person’s unique situation is slightly different. But factoring in the insurance plan and information, the tool would still be able to account for many of those unanticipated costs.”

Weaver said the tool is not yet available at UCHealth Grandview Hospital and UCHealth Pikes Peak Regional Hospital in Woodland Park.

“We have plans to add locations, likely next year,” he said.

Growing sophistication

UCHealth’s pricing tool was developed over the past year by a team of analysts and coders who worked in partnership with Epic, a Verona, Wis.-based health care software company that is the UCHealth system’s electronic medical records provider.

Epic has provided customers with price estimate tools since 2010, said Ryan Krause, vice president of revenue cycle products.

“We came to the realization that it really wasn’t the charge, it was what they have to pay” that patients wanted, Krause said. “Without these sorts of tools, it was a guessing game.”

The tool’s algorithms account for time in the OR and use information about past procedures to determine a median amount.

“It looks at the organization’s providers that are performing surgeries [for example, a knee replacement] and looks at the implants they have used in the past,” Krause said.

Although fees for outside providers aren’t included, “hospitals typically communicate that to a patient,” Krause said. “So even if it’s not included in the number, our customers try to make sure the patient is not surprised.”

All Colorado hospitals have price information on their websites or available if a patient asks, Lonborg said.

“The Legislature in 2017 required hospitals to do that,” she said. “They all have basic price lists for the top procedures performed in their hospitals but not necessarily comprehensive lists.”

The lists allow patients to shop for best pricing for some procedures, but the prices “are what someone who had no insurance would be charged — truly an estimate,” Lonborg said. “That’s what makes this tool so innovative — what my individual responsibility is today if I have that procedure. We know from research and talking with patients that they wanted this information from their trusted hospital.”

Penrose-St. Francis Health Services Communications Manager Andrea Sinclair said Centura Health has a “lookup cost” tool on its website at centura.org that provides pricing information for common procedures by procedure and/or location.

“The pricing information provided on the website is intended to give self-pay patients, who have scheduled services, an estimate of the prices and expected payment amounts for commonly provided health care services at Centura Health hospitals,” Sinclair said in an email.

“The pricing only covers the specific service listed and provided through the hospital and does not include complicating factors or professional fees for services such as those provided by a physician, surgeon, pathologist, anesthesiologist, radiologist, nurse practitioner or other independent practitioners,” she said. “While the hospital attempts to estimate the prices of hospital care as accurately as possible, there may be significant variations between the prices listed and the actual price reflected on the final bill.”

Sinclair said that “as far as I know, Centura Health and Penrose-St. Francis are not currently working on a new or updated pricing lookup tool.”

How secure is it?

Security is a growing concern for all online interactions, especially for sensitive information such as electronic medical records.

Confidentiality and security of protected health information are required by the Health Insurance Portability and Accountability Act, passed by Congress in 1996.

According to a survey by the University of Illinois at Chicago, as of mid-2016, about 90 percent of hospitals have EMR technology, and as of this year, 66 percent of Americans use a mobile app to manage health-related issues.

One study cited by the university noted that about 90 percent of health care organizations experienced data breaches in the past two years that included both outside hacking and internal security breaches.

UCHealth and Epic said that they have taken steps to safeguard patient privacy and security.

Weaver said UCHealth’s electronic health record platform “is one of the most secure that is available. … The new tool is built out within our EMR within our existing patient portal. This is the same portal patients are already using to access their records, refill prescriptions and get test results. The only additional step is that the EMR is connecting with the patient’s insurance provider.

“Security-wise, it’s no different than what we already have been using for a few years. It is very secure, and our IT folks regularly perform audits and tests on the EMR to ensure it’s very safe and protected from any kind of attempts to access it.”

Asked about security, Epic responded in an email stating that security measures are designed into EMR software “from the ground up to keep protected health information secure. The company’s software is developed in-house, and staff that assists UCHealth in maintaining and upgrading its EMR software is “trained and well versed” in properly handling protected health information.

“We have extensive experience with the cybersecurity challenges presented by a large-scale software implementation and have helped groups throughout the U.S. and around the world meet their data privacy and security obligations,” Epic stated.