Johns Hopkins Physicians Propose Measures to Improve Medical Billing

U.S. consumers are becoming increasingly overwhelmed with their healthcare bills, and the issue continues to be in the national spotlight. Looking to address this challenge, two Johns Hopkins Medicine physicians are now proposing five quality measures to improve medical billing.

Simon Mathews, M.D., and Martin Makary, M.D., detailed their proposals in the Feb. 4, issue of The Journal of the American Medical Association (JAMA). They referenced a 2019 report from the U.S. Consumer Financial Protection Bureau that analyzed a national representative sample of 5 million consumers, finding that more than 25 percent of individuals had delinquent debt on their credit reports, with medical bills accounting for 58 percent of all debt. 

What’s more about two in three Americans said they are either very worried or somewhat worried about unexpected medical bills, compared to only 41 percent who are concerned about not being able to pay their rent or mortgage, according to the Kaiser Family Foundation. And, a 20/20 Research report found that 64 percent of patients said they delayed or neglected seeking medical care in the previous year because of concerns about high medical bills.

As such, the Billing Quality 5-Star Rating System that Matthews and Makary propose includes the following measures:

• Itemized bills – Are patients routinely provided an itemized bill with items explained in plain English?
• Price transparency – Are patients provided real prices for common “shoppable” services when they ask?
• Service quality – Can patients speak with a billing representative promptly about a concern they have about their bill and be informed of a transparent review process?
• Suing patients – For patients who have not entered into a written agreement specifying a price for a medical service, does the institution sue patients to garnish their wages, place a lien on their home or involuntarily withdraw money from a patient’s income tax return?
• Surprise bills ­– Are out-of-network patients paying out of pocket expected to pay more than the region-specific, reference-based price [a price outside of that set by traditional insurance carriers]? And, are patients billed for complications stemming from National Quality Forum (NQF) serious reportable events?

The NQF promotes patient protections and healthcare quality through measurement and public reporting. In 2009, it established the first list of serious reportable events (also known as “never events”), a set of largely preventable and harmful clinical practices and behaviors — such as operating on the wrong part of the body or having to remove a foreign object left behind during surgery — that should never occur.

“In recent years, patient care and outcomes have been significantly improved by applying quality science to medicine, benchmarking the performance of both healthcare providers and facilities, yet there are no standardized metrics for billing quality,” said Makary, professor of surgery at the Johns Hopkins University School of Medicine and an authority on healthcare quality.

“Given the wide variation in both pricing and collection practices by hospitals, measures of billing practices are needed,” the authors stated in the JAMA article. “Billing quality is a type of medical quality.”

They also noted that “…metrics of billing quality could be used to create public accountability for U.S. hospitals” and that “… incorporating measures of billing quality into reports of overall hospital quality could provide patients with a more complete assessment of a given medical center or practice.”