{"id":1320,"date":"2014-02-08T21:23:22","date_gmt":"2014-02-08T10:23:22","guid":{"rendered":"http:\/\/blog.panicola.com\/?p=1320"},"modified":"2014-02-08T21:23:22","modified_gmt":"2014-02-08T10:23:22","slug":"us-pricing-transparency-initiatives","status":"publish","type":"post","link":"https:\/\/blog.panicola.com\/?p=1320","title":{"rendered":"US pricing transparency initiatives…"},"content":{"rendered":"
It looks like they’re moving in the right direction in the US… 11 states have established pricing databases already, but I’d be surprised if they’d incorporated sophisticated visualisation\/prediction tools like I+PLUS.<\/div>\n
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http:\/\/www.kaiserhealthnews.org\/Stories\/2014\/February\/05\/washington-state-lawmakers-looking-to-lift-veil-on-health-care-prices.aspx<\/a><\/span><\/div>\n
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Washington State Officials Want To Lift Veil On Health Care Pricing<\/h1>\n

TOPICS:\u00a0<\/span><\/a>STATES<\/a>,\u00a0<\/span>HEALTH COSTS<\/a><\/p>\n

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By\u00a0Lisa Stiffler, The Seattle Times<\/p>\n

FEB 05, 2014<\/p>\n

This story was produced in collaboration with\u00a0\"\"<\/a><\/p>\n

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What if you had a headache that wouldn\u2019t go away? At the area\u2019s top trauma center, a brain MRI will cost more than $4,600, while an imaging center on the Eastside will charge $900.<\/p>\n

Need your tonsils out? A Kirkland nasal-and-sinus clinic will charge you $2,200, but the surgery will be nearly $7,000 at a Seattle hospital. Which would you choose?<\/p>\n

A prime objective of the Affordable Care Act is to bring down America\u2019s health-care costs, which are the highest per person in the world. But how can the U.S. shrink its medical bills if patients are almost always buying health care with no idea what it costs?<\/p>\n

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Washington has been able to do little to shed light on health-care costs, and the state last year earned an \u201cF \u201d for its cost-transparency laws, according to groups promoting health-care reform.<\/p>\n

That soon could change.<\/p>\n

Gov. Jay Inslee and some state lawmakers are pushing for new rules that would create a database listing hundreds of medical procedures, what they will cost at clinics and hospitals statewide, and information about the quality of the medical providers.<\/p>\n

\u201cWe made a decision with the Affordable Care Act to use competition to control costs,\u201d said Bob Crittenden, Inslee\u2019s senior health-policy adviser. \u201cCompetition requires a number of things. You need enough information to make decisions, and we don\u2019t have that right now.\u201d<\/p>\n

The proposal has backing from many big players in medicine and business, but the support is not universal. The state\u2019s largest insurance companies \u2014 Regence Blue Shield and Premera Blue Cross \u2014 oppose requirements to share the treatment prices they\u2019ve privately negotiated with clinics and hospitals.<\/p>\n

There\u2019s also the challenge of pairing cost data with information about the quality of a doctor or hospital. After all, who wants the cheapest physician if he\u2019s also the worst?<\/p>\n

And there are questions whether transparency can drive down prices. Hospitals and clinics have been consolidating, creating fewer, bigger companies and less competition. Lifesaving drugs and treatments might be available from only one company or location, giving patients little choice.<\/p>\n

The biggest question is whether patients will seek this information and use it to shop more wisely. Transparency supporters think the public is ready for them to pull back the curtain on cost and quality.<\/p>\n

\u201cMore information will beget more curiosity,\u201d said Mary McWilliams, executive director of the Washington Health Alliance, a nonprofit that has earned national kudos for tracking the quality of health-care delivery.<\/p>\n

\u201cI think people have assumed it\u2019s all the same quality and all the same cost,\u201d she said. \u201cGetting them to recognize that it\u2019s not all the same is the first threshold.\u201d<\/p>\n

\u201cHuge price variation\u201d<\/strong><\/p>\n

When Jeff Rice was dinged $200 for cholesterol blood work that should have cost $20, the Tennessee-based physician turned his frustration into a business opportunity.<\/p>\n

In 2008, Rice launched Healthcare Bluebook, a company that collects data on what insurance companies pay for medical care, then calculates a \u201cfair price\u201d for procedures from allergy tests to heart surgery. Consumers can search for prices for free online and use the information as a benchmark to shop around.<\/p>\n

\u201cMany patients don\u2019t know there is this huge price variation,\u201d Rice said.<\/p>\n

There are other transparency tools available, but all have their limitations. Many insurance companies have online cost-comparison tools for their customers. A recent search on the Aetna site found prices for roughly 30 common procedures, while Regence lists prices for 350 services.<\/p>\n

On the quality side, the Washington Health Alliance publishes \u201cCommunity Checkup Report,\u201d which evaluates the quality of doctors, clinics and hospitals. The national Leapfrog Group scores hospitals.<\/p>\n

In coming months, lawmakers in Olympia will consider various proposals to expand and greatly improve such transparency. One bill would require insurance companies to enhance their shopping tools to include price and quality information side-by-side.<\/p>\n

Recent hearing<\/strong><\/p>\n

A more controversial proposal would create an \u201cAll-Payer Claims Database.\u201d Hospitals and clinics have a \u201cbilled\u201d rate for services, but insurance companies negotiate lower \u201callowed\u201d rates, the amount they agree to actually pay for a procedure. The legislation would require payers \u2014 mostly insurance companies \u2014 to reveal what they are spending on services at different locations, so the data could be compiled into a database available to everyone.<\/p>\n

At a recent hearing for the bill, representatives from the Washington State Hospital Association, Washington State Medical Association, Seattle Metropolitan Chamber of Commerce and the National Federation of Independent Business all testified in support of creating the database.<\/p>\n

Only Regence and Premera officials spoke against it.<\/p>\n

The insurance companies carefully guard the rates they negotiate. They consider it proprietary information they are not keen to share with competitors, health-care providers and others.<\/p>\n

\u201cWe simply do not believe that [the All-Payer Claims Database] has any history of demonstrating any meaningful cost or quality improvement,\u201d said Premera\u2019s Len Sorrin, at the hearing.<\/p>\n

The companies do, however, support cost tools for their own customers. A spokesman for Regence testified that searching for prices drives patients to lower-cost options.<\/p>\n

Databases in 11 states<\/strong><\/p>\n

So far, at least 11 states have created these databases in various forms, and many more are interested. Most of the databases were built in 2008 or later, and there\u2019s little information on their effects on costs or quality.<\/p>\n

But the world of health insurance is changing. Deductibles \u2014 the amount a patient must pay before an insurance company starts covering medical bills \u2014 are going up. More than one-third of insured workers have deductibles of $1,000 or more, and many plans also have \u201ccoinsurance,\u201d which sets a percentage of medical bills patients must pay even if they\u2019ve reached their deductible cap.<\/p>\n

Gone are the days of visiting the doctor and paying a $15 copay. Patients are more frequently footing the bill.<\/p>\n

\u201cWhen it\u2019s your money, you ask a lot more questions about what things cost,\u201d said Rice, the founder of Bluebook.<\/p>\n

But shopping for health care can be more complicated than buying other essentials.<\/p>\n

Transparency supporters like to illustrate the influence of price by comparing it with buying gasoline. Most drivers check the posted per-gallon price before filling up. If one station offered gas at $4 a gallon, they would drive past the pump offering it for $20 a gallon \u2014 a degree of price difference seen in some medical services.<\/p>\n

But is that the right metaphor? What if you\u2019re driving on fumes and there\u2019s no other pump for miles around? When you\u2019re a desperate shopper, chances are you\u2019ll pony up if you can.<\/p>\n

Challenges, limitations<\/strong><\/p>\n

Some argue that by publishing the cost information, the cheaper locations will raise their prices rather than the expensive sites dropping theirs. Douglas Conrad, a professor in the University of Washington\u2019s School of Public Health, called that argument a red herring. Over time, he said, the prices come down, whether through market forces or action by antitrust authorities.<\/p>\n

The relationships patients develop with their doctors pose potentially more difficult complications.<\/p>\n

Conrad acknowledges the challenges and limitations to how much influence transparency can exert on the health-care system, but he thinks it can make a positive difference.<\/p>\n

\u201cIf price and quality information get out there, and there is a push by the state to force transparency where it\u2019s been difficult to get … that could change things,\u201d Conrad said. \u201cThe promise is there.\u201d<\/p>\n<\/div>\n

We want to hear from you:\u00a0Contact Kaiser Health News<\/a><\/strong><\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

It looks like they’re moving in the right direction in the US… 11 states have established pricing databases already, but I’d be surprised if they’d incorporated sophisticated visualisation\/prediction tools like I+PLUS. http:\/\/www.kaiserhealthnews.org\/Stories\/2014\/February\/05\/washington-state-lawmakers-looking-to-lift-veil-on-health-care-prices.aspx Washington State Officials Want To Lift Veil On Health Care Pricing TOPICS:\u00a0STATES,\u00a0HEALTH COSTS By\u00a0Lisa Stiffler, The Seattle Times FEB 05, 2014 This story … Continue reading US pricing transparency initiatives…<\/span> →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5,8,9,22,3],"tags":[],"class_list":["post-1320","post","type-post","status-publish","format-standard","hentry","category-data-saving-lives","category-entrepreneurship","category-healthcare","category-policy","category-rapid-learning-health-systems"],"_links":{"self":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/1320","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1320"}],"version-history":[{"count":1,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/1320\/revisions"}],"predecessor-version":[{"id":1321,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=\/wp\/v2\/posts\/1320\/revisions\/1321"}],"wp:attachment":[{"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1320"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1320"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.panicola.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1320"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}