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:
Wow that's a lot of dough for
knee replacements.
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