The House has 3 bills under consideration for promoting health care pricing transparency. Unfortunately, there is no commitment for moving the legislation through this year. And no bills introduced in the Senate yet.
The worst indication of where this may be heading came from Frank Pallone, chairman of the Energy and Commerce health subcommittee. “The concern I guess is about the unintended consequences of too much transparency,” he said. Apparently he believes such transparency will make prices go higher since Peter Orszag stated so back in 2008. If we assume that future health benefits will preserve the worst parts of the insurance models, then maybe that is possible.
However, if we look at private reform and adopt the newer benefit designs with consumerism, then we are much more likely to see prices fall as consumers engage in their care decisions.
Until the legislature brings meaningful pricing disclosure requirements, consumers can find fair price estimates for free at Healthcare Blue Book.
The three bill were summarized by California HealthLine
Bill Details
HR 4700: The bill -- sponsored by Rep. Steve Kagan (D-Wis.) without any Republican support -- would require hospitals, physicians, nurses, pharmacies, and a number of manufacturers and vendors to disclose publicly the prices they would charge patients. The HHS secretary would levy a fine on providers and vendors that fail to comply with the requirement (Ethridge, CQ Today, 5/6).
HR 2249: Cosponsored by Texas Reps. Gene Green (D) and Michael Burgess (R), the bill calls for transparency in hospital charges (Pecquet, "Blog Briefing Room," The Hill, 5/6). The legislation also would expand reporting requirements to all 50 states and require insurance companies to disclose out-of-pocket cost estimates for a number of medical procedures (Reichard, CQ HealthBeat, 5/6).
HR 4803: The proposal, sponsored by House Energy and Commerce Committee ranking member Rep. Joe Barton (R-Texas) with broad Democratic support, would cover ambulatory surgical centers serving patients who are not hospitalized after their operation ("Blog Briefing Room," The Hill, 5/6). It would require the centers, as well as hospitals and private and public health insurers, to disclose to their patients and customers information about the costs for services they provide and the items and services that they cover, respectively (CQ Today, 5/6).
See also comments at:
The Hill
Thursday, May 13, 2010
Sunday, May 2, 2010
Wisconsin Legislation for Price Transparency
In the fall of 2009 there were a lot of articles on 'facility fees' that are added to doctor's bills for office visits when the doctor works for a hospital.
Wisconsin is now considering requiring pricing transparency for the extra fees. Proposed legislation (AB 207) would require clinics that charge "facility fees" - meant to cover extra costs incurred by hospital-owned facilities - to tell people about them at the time they make appointments and to provide an estimate of what they will be.
Wisconsin has already passed one law to encourage pricing transparency, thought the law does not take effect until 2011. Wisconsin Act 146 requires hospitals and other health care providers to give patients a list of common procedures and what the provider charges for them, as well as what Medicare and insurers typically pay for them. This will provide some very useful information for patients.
In addition, Wisconsin is considering a law that would would require health care providers to give patients an estimate of the cost of any procedure, test or other service if it is expected to be more than $500. It would also require more disclosure to patients by insurance companies of the coverage amounts for certain medical services and estimates of out-of-pocket costs and costs for services from out-of-network providers. (Assembly Bill 539)
Wisconsin is now considering requiring pricing transparency for the extra fees. Proposed legislation (AB 207) would require clinics that charge "facility fees" - meant to cover extra costs incurred by hospital-owned facilities - to tell people about them at the time they make appointments and to provide an estimate of what they will be.
Wisconsin has already passed one law to encourage pricing transparency, thought the law does not take effect until 2011. Wisconsin Act 146 requires hospitals and other health care providers to give patients a list of common procedures and what the provider charges for them, as well as what Medicare and insurers typically pay for them. This will provide some very useful information for patients.
In addition, Wisconsin is considering a law that would would require health care providers to give patients an estimate of the cost of any procedure, test or other service if it is expected to be more than $500. It would also require more disclosure to patients by insurance companies of the coverage amounts for certain medical services and estimates of out-of-pocket costs and costs for services from out-of-network providers. (Assembly Bill 539)
Friday, April 30, 2010
Alfie Tackles Health Literacy
Jeff Knott is a strong champion of health literacy. Based on his personal experiences with the health care system, he is committed to helping others understand the system and advocate for themselves to receive quality care.
He combines comedy with education to provide a fun learning experience for patients.
Watch for Alfie. You can see the educational videos on youtube.
Here are a few of them.
Dirty Magazines
Nurse Practitioners
Staph Infections
He combines comedy with education to provide a fun learning experience for patients.
Watch for Alfie. You can see the educational videos on youtube.
Here are a few of them.
Dirty Magazines
Nurse Practitioners
Staph Infections
Friday, April 2, 2010
AHIP Calls for Transparency
The consequence of health reform continue to unfold.
One interesting development is the response by health plans to the HHS request for transparency of price increases.
AHIP wrote a letter to HHS suggesting that health plans would be glad to provide transparency into rate increases, and would like the same standard to be applied to providers.
The letter reads in part:
"As you request transparency from our members, we urge you also to consider pursuing transparency for hospitals, physicians, pharmaceutical and device companies, and other suppliers. Consumers should have data on year-to-year price increases in these sectors, as well as quality performance information. We believe this is an opportunity to ask of all other sectors what you are asking of health plans. Pursuing transparency in these sectors is essential both to educate consumers about what drives health care costs and to ensure that patients and their doctors have the information and decision support tools they need to make informed decisions in accessing care and in choosing among providers and care options."
Asking health care providers to explain price increases implies that consumers know what prices are to begin with.
What an excellent idea.
The Healthcare Blue Book welcomes the idea that HHS will encourage all providers to provide real pricing transparency to consumers.
One interesting development is the response by health plans to the HHS request for transparency of price increases.
AHIP wrote a letter to HHS suggesting that health plans would be glad to provide transparency into rate increases, and would like the same standard to be applied to providers.
The letter reads in part:
"As you request transparency from our members, we urge you also to consider pursuing transparency for hospitals, physicians, pharmaceutical and device companies, and other suppliers. Consumers should have data on year-to-year price increases in these sectors, as well as quality performance information. We believe this is an opportunity to ask of all other sectors what you are asking of health plans. Pursuing transparency in these sectors is essential both to educate consumers about what drives health care costs and to ensure that patients and their doctors have the information and decision support tools they need to make informed decisions in accessing care and in choosing among providers and care options."
Asking health care providers to explain price increases implies that consumers know what prices are to begin with.
What an excellent idea.
The Healthcare Blue Book welcomes the idea that HHS will encourage all providers to provide real pricing transparency to consumers.
Monday, March 29, 2010
Walgreens Pulls Out of Mediciad Program
Walgreens announced that it was pulling out of Washington state's Medicaid program because the state was paying prices that did not cover the actual cost of many of the program's medications.
For many years the government programs (Medicare and Medicaid) have paid lower prices than other payers. They are able to do this because of the hidden subsidies that other payers pay to make up for short falls in government program payments.
With health reform upon us, we will need to closely watch these trends. Part of the reform package brings Medicaid payments up to Medicare levels. But will this create even more pressure to further lower Medicare rates?
On top of the hidden subsidies, the private payers will now pay a premium tax too.
Does this ultimately push the private insurers out of business and leave us with a single payer option? Or does the government v. private pay differential grow enough that we end up at a two tiered system?
Time will tell, but as providers refuse to deal with certain payers, politicians and the markets will react.
We welcome the provider feedback (Walgreens as an example) that incentives can change provider behavior. If politicians and the markets would incorporate more consumer incentives, then maybe we will end up with a value based system that patients will embrace.
For many years the government programs (Medicare and Medicaid) have paid lower prices than other payers. They are able to do this because of the hidden subsidies that other payers pay to make up for short falls in government program payments.
With health reform upon us, we will need to closely watch these trends. Part of the reform package brings Medicaid payments up to Medicare levels. But will this create even more pressure to further lower Medicare rates?
On top of the hidden subsidies, the private payers will now pay a premium tax too.
Does this ultimately push the private insurers out of business and leave us with a single payer option? Or does the government v. private pay differential grow enough that we end up at a two tiered system?
Time will tell, but as providers refuse to deal with certain payers, politicians and the markets will react.
We welcome the provider feedback (Walgreens as an example) that incentives can change provider behavior. If politicians and the markets would incorporate more consumer incentives, then maybe we will end up with a value based system that patients will embrace.
Sunday, March 21, 2010
Health Reform and Consumerism
Regardless of your position on the current health reform, it will soon impact consumerism movements that have been shaping the healthcare landscape and helping to hold prices down.
Consumerism provides individual patients with some economic responsibility as they make decisions regarding their healthcare; hoping to strike a balance between making care affordable but also making sure those paying for care are getting value for the resource they spend.
The reform legislation will probably change over time, but as of today, based on the Senate's bill; here are some of the impacts on consumerism:
Promoting consumerism:
Linking payments to hospitals to providers based upon quality of care instead of volume of services (2012).
Linking payments to physicians to providers based upon quality of care instead of volume of services (2013).
Taxing high cost insurance plans (2013).
Increasing the threshold for claiming itemized deductions for medical expenses (2013).
Limiting Consumerism:
Eliminating Lifetime Limits and Restricting Use of Annual Limits (2010).
Covering Preventive Health Services at 100% (2010).
Reducing the Part D “Donut Hole” or Coverage Gap (2010).
Limiting Health Flexible Savings Account Contributions (2011).
Eliminating Annual Limits on health insurance coverage (2014).
It will be interesting to see how the final legislation changes over time and what its ultimate impact will be on consumerism.
Based upon patient usage of the Healthcare Blue Book, we know that many patients are very capable of finding high quality care at reasonable prices when they have an incentive to do so.
Consumerism provides individual patients with some economic responsibility as they make decisions regarding their healthcare; hoping to strike a balance between making care affordable but also making sure those paying for care are getting value for the resource they spend.
The reform legislation will probably change over time, but as of today, based on the Senate's bill; here are some of the impacts on consumerism:
Promoting consumerism:
Linking payments to hospitals to providers based upon quality of care instead of volume of services (2012).
Linking payments to physicians to providers based upon quality of care instead of volume of services (2013).
Taxing high cost insurance plans (2013).
Increasing the threshold for claiming itemized deductions for medical expenses (2013).
Limiting Consumerism:
Eliminating Lifetime Limits and Restricting Use of Annual Limits (2010).
Covering Preventive Health Services at 100% (2010).
Reducing the Part D “Donut Hole” or Coverage Gap (2010).
Limiting Health Flexible Savings Account Contributions (2011).
Eliminating Annual Limits on health insurance coverage (2014).
It will be interesting to see how the final legislation changes over time and what its ultimate impact will be on consumerism.
Based upon patient usage of the Healthcare Blue Book, we know that many patients are very capable of finding high quality care at reasonable prices when they have an incentive to do so.
Thursday, March 11, 2010
Save Big
Elisabeth Leamy who is the Consumer Correspondent for the Good Morning America show has a new book out called Save Big.
In addition to tips on expenses around housing, transportation, loans and grocery shopping, she has an entire section devoted to healthcare costs.
It is definitely worth reading and can help consumers with health insurance suggestions as well as suggestions for finding care and prescriptions.
Not surprisingly she recommends negotiating with your doctor.
We were glad to see that she suggested using The Healthcare Blue Book as a great place to find out how much your care should cost. As Leamy reports, the Healthcare Blue Book's fair price is "a great starting point for discussion- and negotiation."
In addition to tips on expenses around housing, transportation, loans and grocery shopping, she has an entire section devoted to healthcare costs.
It is definitely worth reading and can help consumers with health insurance suggestions as well as suggestions for finding care and prescriptions.
Not surprisingly she recommends negotiating with your doctor.
We were glad to see that she suggested using The Healthcare Blue Book as a great place to find out how much your care should cost. As Leamy reports, the Healthcare Blue Book's fair price is "a great starting point for discussion- and negotiation."
Subscribe to:
Posts (Atom)
Posts
