Search This Blog

Tuesday, February 4, 2014

National Review of Mandates for Disclosure of Hospital Charges



Do you know what your doctor charges? What will your surgery cost? How does that hospital’s fee  compare to other facilities with comparable outcomes? Consumer driven health care means the health care purchaser seeks information, chooses the treatment facility, and pays for part or all of the cost, using publicly available information. This is referred to as health care transparency and last month’s article was on hospital price transparency. This article reviews the type of information that is available to health care purchasers and what some states are doing to promote public disclosure for the cost of health services.

Look at the Nation
According to the National Center for State Legislatures. March 18, 2013 Report Card on State Price Transparency Laws, the following states have passed laws mandating disclosure of hospital pricing information[1]:
California-exempts small and rural hospitals and only requires a written copy of hospital charges on site for health care practitioner or facility charges, which may be posted on the hospital’s web site.
Colorado-disclosure on web site of practitioner or facility charges and actual reimbursements and is managed through the division of insurance
Illinois-disclosure via a written copy of charges must be available on site of practitioner or facility and be available on a website for the Consumer Guide to Care
Iowa-disclosure on web site of practitioner or facility charges and coordinated by the state hospital association
Kentucky-disclosure on web site of practitioner and facility charges
Maine-partial disclosure of practitioner or facility charges and actual reimbursements upon request
Massachusetts-disclosure on web site of practitioner and facility charges and actual reimbursements
Minnesota- partial disclosure on web site of practitioner or facility charges and actual reimbursements and coordinated by the commissioner of health in cooperation with the state hospital association
Nevada-disclosure on web site of both practitioner or facility charges
New Hampshire-disclosure on web site (under development) of both practitioner and facility charges and actual reimbursements, using HEDIS data
South Dakota- disclosure on web site of both practitioner or facility charges and reports to the Association of Health Care Organizations
Utah-disclosure on web site of practitioner and facility charges and reported under Utah Pricepoint
Vermont-disclosure on web site of practitioner and facility charges and coordinated through the Office of the Insurance Commissioner
Virginia- disclosure on web site of practitioner and facility charges and is coordinated through the Office of the Insurance Commissioner
Wisconsin-disclosure on web site of practitioner or facility charges

Home State View
Washington State is not among the states which mandate health care providers make price information available to the public. This is the reason, former Congressman and current Governor, Jay Inslee is advocating for a health care price transparency law in Washington State. His approach is to require the insurance companies to disclose what they actually pay for services, which they are loath to do.  It would be easier to have the hospital’s disclose what they charge as they already have to do that for Medicare and all reimbursement formulas impact their budgeting. This disclosure would allow the public to compare ranges of price and quality information. And, as cited in the December article on hospital transparency, there are other ways to find out about actual reimbursement.
The disparity between hospital gross charges and the actual reimbursements are discussed in Unraveling U.S. Health Care-A Personal Guide, which is currently ranked in the Amazon top 50 for health care and medicine books. For more information go to: http://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972/ref=sr_1_1?s=books&ie=UTF8&qid=1391482693&sr=1-1&keywords=unraveling+u.s.+health+care%2C+a+personal+guide

Clinical Quality Compared to Price
Also, with regard to the quality of care issue raised by those concerned about price transparency, first I used this government tool http://www.medicare.gov/hospitalcompare/search.html  to review clinical outcomes or health care quality information. Secondly, I compared it to Medicare reimbursement or price information for common treatments at facilities which voluntarily report patient safety information to the Leapfrog Group, a nonprofit patient safety group. The first analysis included non-pediatric hospitals that scored 100% for five out of the seven patient safety criteria for the current Leapfrog Group annual survey[2]. None of Washington’s hospitals scored a perfect seven or a perfect six for the applicable safety criteria. Finally, the review also incorporates hospitals which reported to Leapfrog, but didn’t make the 100% for four out of seven criteria.

Hospitals which scored 100% for five of the seven Leapfrog criteria and include the Medicare Score:
Northwest Hospital-Heart failure deaths were worse than the national average and this facility was also  4% more expensive than the state average.
Virginia Mason Medical Center-Had fewer deaths from pneumonia, was equal to the national average for heart attack and heart failure deaths, and  the cost of care was 3% more than the state average.

Hospitals which scored 100% for four of the seven Leapfrog criteria and include the Medicare Score:
Evergreen-The rate of death for any of the three conditions was equal to the national average and the cost of care was 2% over the state average.
Kadlec-The rate of death for heart failure patients was worse than the national average and the cost of care was equal to the national average, making this some of the most expensive health care in the state.
Multicare-Good Samaritan-The rate of death from pneumonia was worse than the national average but the other metrics were equal and the cost of care is 1% higher than the state average.
Swedish(First Hill)-Had rates of death from pneumonia, heart failure, and heart attack equal to the national average and was equal to the statewide average cost of care. The Cherry Hill facility was 7% more expensive than the state average cost of care for these criteria.
University of Washington Hospital-The rates of death for any of the listed conditions were no different than the national average and though the facility was less expensive than the national average it was 4% more expensive than the state average.

Sampling of Hospitals which did not make the Leapfrog 100% criteria grade for at least four components
Allenmore (Tacoma General, Multicare)- Hospital-Rates of death are equal to the national average but the cost of care is 2% more expensive than the state average.
Harborview-The clinical results are equal to the national average for these metrics but the cost of care is 6% higher, probably reflecting the intensive care this regional trauma center provides.
Harrison Medical Center-Rates of death from heart failure are equal to the national average, but cost of care was 5% more expensive than the state average per Medicaid patient.
Overlake Medical Center-Though the rates of death for any of the criteria were equal to the national average, it is 3% more expensive to be treated here than the statewide average cost per Medicaid patient.
 For a state by state analysis of what the rest of the nation is doing for patient safety, go to chapter seven of Unraveling U.S. Health Care, your personal guide.

In conclusion, Washington State is not currently a leader in health care transparency for hospital costs nor in patient safety as it does not require public disclosure of the true cost of care nor does it reveal hospital patient safety events to the general public, by facility, as other states do. If we are going to be engaged in consumer driven health care, we must insist on adding these components to our scorecard
And this is the healthpolicmaven signing off.

1 comment: