If you are a patient in need of surgery, you may very well find yourself at a loss when it comes to getting a price estimate before that surgery. If your health plan does not have an online health care cost calculator that is accessible and accurate, or if you are uninsured, chances are you won’t be successful in trying to determine the costs beforehand.
Your best bet for getting a price estimate before surgery might be to get a list of Current Procedure Terminology (CPT) codes from your doctor’s office, and then call the hospital or surgery center and ask the billing department for the prices associated with each code to sum up. However, according to a recent survey in Massachusetts, the billing department is unlikely to be prepared to handle your query. This process is also not ideal and is a lot to ask of a consumer.
Although a handful of states across the country have made progress in making health care costs more transparent to consumers, a lot more work needs to be done. A recent review of state transparency laws conducted by my organization, Catalyst for Payment Reform, and the Health Care Incentives Improvement Institute (HCI3), shows not much progress has been made in the past year toward making health care prices more accessible to the public.
In our 2015 Report Card on State Price Transparency Laws, we reviewed whether states had passed legislation or regulations requiring health care price information be made public. We also examined if those laws provided residents with access to meaningful price information through public websites and whether states used all-payer claims databases (APCDs) as data sources for those sites (APCDs can provide a more accurate view of the quality of care and historical total costs by provider).
The results of our analysis show 90 percent of states fail to provide adequate price information to consumers. This is the third installment of the Report Card. Since last year, there have been few changes, with most states receiving an “F” grade. The grades are based on legislation passed during the prior year’s legislative session; this year’s report reflects any bills enacted in 2014 at the state level.
However, this bleak picture masks the recent legislative and regulatory activity that has sprung up around the country. States like Connecticut and New York are still assembling their all-payer claims databases and working on consumer-facing websites. Maryland is in the process of embarking on a significant effort to publish prices on health care services, and the state of Washington recently enacted a new law that establishes a statewide all-payer claims database. We expect continued progress, even if it is at a slow pace.
New Hampshire returned to a high score this year after a brief hiatus due to an inactive website last year. Its rebound shows that even small states with few resources can develop and maintain a useful and consumer-friendly website on health care prices. Conversely, Massachusetts’s grade dropped precipitously due to shutting down MyHealthCareOptions, a website that had publicly accessible price information on health care services.
New Hampshire
In our 2014 report, New Hampshire was given an “F” due to the lack of a functioning public price transparency website. However, its new website, NH HealthCost, is a prime example of a price transparency website built with consumers in mind. The site accounts for both insured and uninsured patients and provides great details on the methodology in consumer-friendly terms. This year the state received an “A.”
Massachusetts
Massachusetts has traditionally been a leader in health care transparency and received high honors in past Report Cards. However, in 2014, legislation went into effect that placed the responsibility of transparency on health plans and the government-mandated website went dark. While we believe that health plans play an important role and should assist members by helping them estimate costs, the lack of a public website with price information leaves out entire populations of consumers, especially the uninsured. In addition, the health plan websites vary in the amount of information they provide. A statewide transparency tool creates uniformity. For this reason, Massachusetts dropped to an “F” in this year’s Report Card.
States can and should continue to experiment and research the most effective ways to communicate health care prices to different stakeholders, and not leave it up to those who have argued to keep prices secret.
As I noted in my previous post about last year’s Report Card, price transparency is one of the core building blocks of a higher-value health care system. Purchasers and consumers need transparency to help contain health care costs and reduce unknown and unwarranted price variation in the system. Consumers also need to be informed when making health care decisions as they assume greater financial responsibility. For the uninsured, transparency may mean the difference between financial survival and bankruptcy.
Countering Legal Arguments Against Transparency
Legislative sessions are still underway and some proposed transparency bills may still pass. But many won’t due to pressure from providers, payers, and other suppliers to the industry who still benefit from price opacity. That pressure often rests on spurious arguments about price as a trade secret and/or the potential for a state law on price transparency to violate contractual terms between payers, providers, and suppliers — arguments legislators and the media often accept.
To outline the legal arguments raised against price transparency, and how best to address them, we teamed with the UCSF/UC Hastings Consortium on Law, Science and Health Policy to write a legal brief. We believe it is important for the public, and especially the media, to understand what legal arguments are valid and question the others.
A crucial point for legislators and the media is that states that are serious about ensuring price transparency for consumers have successfully brushed aside the spurious arguments. With that said, we hope the legal brief helps legislators and the media focus on the right considerations.
No comments:
Post a Comment