Healthcare Costs Becoming More Transparent
An all-claims all-payer data base will reveal the true cost of healthcare services charged by hospitals and providers
That’s all about to change as transparency moves into the healthcare realm.
Oregon’s about to develop a data base that will include all the medical claims and their costs paid by insurance companies and include Medicare and Medicaid.
Vendors are lining up to seek a contract to create such a data base – an RFP on the streets closes on Aug. 19, according to Sean Kolmer, deputy administrator of the Office of Oregon Health Policy and Research.
“The data base will be up and operational this fall,” predicted Kolmer, with information flowing into the state.
But it’s still unknown if the public will actually be able to compare specific hospital and physician charges. That recommendation lies in the hands of an advisory group, which will begin meeting this fall and include “the usual suspects,” Kolmer said -- payers, providers, consumer advocates, researchers, public health officials and those interested in how this data should be released – which will begin meeting this fall.
“This group won’t be a government body and will have a limited time; it won’t be a standing committee.” Kolmer said. Patient data will be protected in compliance with HIPAA regulations. At no point will a person’s name be associated with the cost of a particular procedure.
“We need to make sure we have the conversation that Oregon hasn’t had yet – where is the money flowing and how it’s being spent,” Kolmer said. “Hopefully there’ll be value in what’s being created and it will answer some questions we haven’t been able to answer such as how much money is going through the healthcare system in Oregon and what’s driving costs.”
Until a contract has been signed with a vendor, Kolmer was reluctant to disclose the cost of setting up such a system.
Kolmer also praised Nancy Clarke, outgoing executive director of the Oregon Quality Corporation, for her tremendous work in building trust among providers. “Because of her involvement, we have a big leg up and hope to work closely with the Quality Corp and have them guide on how to do the network.”
Legislation adopted in 2009, known as House Bill 2009, called for the creation of such a data base. But Oregon can’t call itself a leader in this regard. At least seven other states have either begun a similar system or in the implementation stages. They include Utah, Minnesota, Tennessee, New Hampshire, Vermont, Massachusetts and Maine.
For more information
Read the position paper on Oregon’s all-claims all-payer data base by clicking here
For a look at the Oregon hospital association's Price Point which offers average prices for certain procedures click here.
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Comments
Finally, a small step in the right direction. Though it worries me that a "panel" will decide what and how much information is appropriate for the public to known. It is ridiculous that we do not know what we are being charged for the services doctors and hospitals provide. Would anyone sign off to buy a car without knowing the price beforehand or the quality of the automobile? Of course not.! Yet, we go into hospitals and offices everyday not knowing if their quality is good, if your doctor is competent and finally what they are charging you as a consumer. For example if you were to call up to find out the cost of a colonoscopy the first question they will likely ask is "don't you have insurance?" If you persist and say you need to know the price most likely they will have to call you back or find their supervisor etc. etc. and it may take an act of congress to get that information. I can only afford an insurance plan with a very high deductible. Therefore I want to know if my doctor is any good and I want to know what they charge. Unfortunately that is nearly impossible in today's healthcare climate and that is only one of many problems that contribute to the horrendous fees being charged.
Add this one to the list of "nice things" to get done recognizing improved transparency in itself is not an assurance that people will act to shop for price variance or simply continue to defer to "that's my insurance company's problem". Unless various "good reform ideas" are vigorously driven to produce savings at the the premium level, very little likelihood it will happen. This same exposure applies to "pay-for-performance", medical practice guidelines, improved IT systems, prevention, and all the other populist ideas dominating today's cost containment rhetoric. Each makes us feel good all over, while health care costs just continue their relentless increase. Really a shame to see us spend all this money and energy for what has such a low probability of doing the job.
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