On June 29, a Boston Globe reporter tweeted a horrifying scene: a 45-year-old woman had fallen between a train and the platform, cutting her leg to the bone, but she begged those nearby not to call an ambulance, fearing it would be too expensive.
Details of the accident
According to a police report, the accident occurred at 5:30 p.m. The Boston Globe reports that passengers immediately rushed to the woman's aid. One man supported her back, another passenger placed a cold bottle of water on her leg, and at least 10 people pushed on the train car to free the woman. After her leg was free, a handful of people helped wrap it in a compress, according to Marleny Polanco, a witness to the event.
Maria Cramer, a legal affairs reporter for the Globe, was on the platform at the time and tweeted about the incident. Throughout the event, Cramer reported, the woman begged people not to call an ambulance, fearing that it would cost her thousands of dollars.
— Maria Cramer (@GlobeMCramer) June 29, 2018
The woman did not suffer any broken bones, but according to the police report, she suffered a "serious laceration, exposing the bone" on her left thigh and would need surgery. She was transported to Boston Medical Center.
Incident prompts discussion on US health system
Cramer's tweets sparked a significant online response from Twitter users expressing outrage that the cost of an ambulance would prevent an accident victim from seeking emergency transportation. So far, the tweets have garnered more than 8,000 retweets and over 15,000 likes.
Last week, the editorial board at the New York Times wrote about the event with the headline "This Tweet Captures the State of Health Care in America Today."
Jim Hooley, chief of Boston EMS, clarified that an ambulance transporting a patient within the city could cost anywhere from $1,200 to $1,900. "We just worry about taking care of people," he said. "We don't want to cause them more stress. We just want to reassure them that nothing bad is going to happen to them because of their inability to pay" (Rappleye, Becker's Hospital CFO Report, 7/3; Cramer/Cote, The Boston Globe, 7/2).
Advisory Board's take
Robin Brand, Senior Director, Financial Leadership Council
As human beings, we should be dismayed at this awful, heart-wrenching story. As health care professionals, we should ask ourselves: Can we do better?
The woman's concerns about cost go beyond the control of any single health care stakeholder. It’s no secret that Americans are paying higher health care costs—even those with insurance. And there are many factors that affect cost decisions: The escalating costs of health care in America, the insurance design choices made by policymakers and employers, and the details of each person's financial situation.
But I was most struck by one small facet of this story, one where we can make a difference: This woman believed an ambulance ride would cost her $3,000, when in fact the likely price was only half of that.
Might her reaction have been different if she had known the real price of an ambulance ride, or if she had known better what costs her insurer might cover? It's hard to say. Even a bill of a few hundred dollars is enough to derail the finances of many American families, and in any event, it's not as though an injured woman writhing in pain could be expected to call around for price quotes.
But at least at the margins, providers can try to make prices more transparent, both for patients who are immediately seeking care and for those who may need care in the future.
Providing greater price transparency requires overcoming three common challenges: First, price estimates are often inaccurate and dependent on patient-specific factors; second, even when patients proactively reach out for estimates, they don't often understand the price information provided; and, third, consumers often don't know where to access price information. To address these challenges, progressive organizations can adopt the following three strategies:
- Generate accurate estimates by creating a centralized department to manage all patient requests for price information. Many organizations say that providing price estimates is cumbersome because few staff have access to all information required for an accurate estimate. However, creating a centralized location to both store this information and relay it to patients can reduce per-estimate effort.
- Train staff to clearly explain price information. Providers should train their patient-facing staff (including scheduling, call center, registration, billing and financial counselors) to proactively provide patients with clear information about prices. To train staff to manage difficult conversations, organizations can use a mix of in-person role playing exercises to build staff confidence and expertise, as well as scripting examples to help staff navigate sensitive topics such as out-of-pocket costs and price variation.
- Embed price explanation in patients' bills. Surveys have found that 54% of patients are "sometimes or always" confused by medical bills. Progressive hospitals streamline their estimates and bills to include explanations for common terms, describe concepts in laymen's terms and include spaces for staff to add notes based on patient's comments.
We should be honest about the modesty of these steps. They would not, on their own, have solved the financial worries that so deeply concerned the train victim in Boston. But they can help make your organization a little more transparent and a little more patient-friendly, and that is at least a step in the right direction.
To learn more about tactics to promote price transparency, view our research report on how to grow market share with price transparency. Then, make sure you are following the nine best practices for sharing prices with patients.
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