Photo by Truthout.org via flickr.
Health insurers are taking incremental steps to release information on what they pay to health care providers. Each month, they reveal just a bit more.
This week, Aetna, Assurant Health, Humana and UnitedHealthcare released state and local cost information through the nonprofit Health Care Cost Institute (HCCI) on a consumer site called Guroo.com. The data show the costs for about 70 common health conditions and services and are based on claims from more than 40 million insured individuals, HCCI announced.
No other organization has made these data available, HCCI said. In that way, this release is significant. Or, as the Guroo site says of the data: “The biggest collection of cost information is now at your fingertips, so you know what care really costs.”
Well, not exactly. The data show what insurers paid. Or, as Jason Millman pointed out in The Washington Post, “The site doesn’t break down what a consumer pays for services versus what the insurer pays.” Continue reading
Elisabeth Rosenthal’s latest piece on the craziness of our health care pricing looks at affordability of health care for people covered by the Affordable Care Act.
For people purchasing insurance, premiums are only part of the cost, although they are what many consumers focus on when they choose a plan. There are also deductibles, co-pays, and different rules for in-network and out-of-network care. For people covered by ACA exchange plans, costs can mount, big time, and it can be very confusing for patients to figure out what they are being or will be charged. Continue reading
The Accreditation Council for Graduate Medical Education has rejected a request from AHCJ to publicly release additional information about the successes and failures of physician training programs nationwide.
Earlier this month, AHCJ called upon ACGME to release details about residency programs with less than full accreditation, as well as the rates at which graduates of residency programs pass their board certification examinations. ACGME posts decisions on favorable or less-than-favorable accreditation status but not the reasons for them.
Replying to AHCJ’s Aug. 5 letter, ACGME executive director Thomas J. Nasca, M.D., wrote that the organization would not provide the requested information, citing the confidentiality of ACGME’s review and decision process.
AHCJ president Karl Stark said he was disappointed by ACGME’s response. Continue reading
The post we did on Clear Health Costs got a lot of positive reaction so we asked the team involved in a John S. and James L. Knight Foundation-funded project involving two California public radio stations and the cost-tracking group to tell you more about it in their own words.
In the tip sheet, Lisa Aliferis of KQED, Rebecca Plevin from SCPR and Jeanne Pinder of clearhealthcosts.comgive you a glimpse under thehood of health care costs. “Health care costs both lack transparency and are wildly variable, not just from region to region but sometimes from block to block within the same city,” they begin.
They explain a few basics: what you pay, what insurers pay, what providers are paid, and what almost no one (except some of the uninsured) pays – the Chargemaster price. Even if you can’t build a data collection project, you can write about the variability in your community. “Put a human face on these dollar figures. Talk to people who have felt burned by the cost of a medical procedure, or confused by a huge bill. “ You might be able to find a handful of people who have had the same procedure in the same place – or the same procedure at two facilities just blocks apart in a city, or in adjacent counties in a more rural setting – and find how their experiences differed.
The “How I Did It” article by Lisa Pickoff-White, senior news interactive producer, KQED; Joel Withrow, product manager, KPCC/SCPR; and Pinder is more nitty-gritty. Your organization may not be able to do something on this scale, but it’s still worth a read to see how they approached it, what worked, and what tools they used (not just on the technical side – see the bottom of the post for other project management and collaboration tools). Facing an eight-week deadline they had to coordinate a far-flung team of journalists, data crunchers and developers scattered in Los Angeles, San Francisco, New York, Bialystok, Kiev and Tahiti. (yes, Ukraine and Tahiti.)
Health care costs lack transparency and are wildly variable, not just from region to region but sometimes from block to block within the same city.
It is a complex topic, with chargemaster prices, what insurers paid and what consumers pay (if anything). Then there are the administrative rules set by Medicare and Medicaid and the negotiated rates between insurers and providers.
It’s daunting, but Lisa Aliferis of KQED, Rebecca Plevin of SCPR and Jeanne Pinderof clearhealthcosts.com have teamed up to offer guidance for reporting on health care costs in this new AHCJ tip sheet.
Reporters facing unreasonable delays or inadequate responses from media officials at an agency of the U.S. Department of Health and Human Services (HHS) can bring their complaints to one of three deputy assistant secretaries for public affairs.
In a phone conference on Wednesday between top HHS media officers and AHCJ board members, these officials were named as contacts for reporters having difficulties. Their names and the agencies whose media offices they oversee are listed below.
The phone conference was one in a regular series in which leaders of AHCJ’s Right to Know (RTK) Committee work with the HHS public affairs office to improve government transparency and access to information and experts.
As chair of the RTK committee, I joined board President Karl Stark and RTK Vice Chair Felice J. Freyer in representing AHCJ. We spoke with Dori Salcido, assistant secretary for public affairs, News Division Director Bill Hall, and Deputy Assistant Secretary Mark Weber. Continue reading
Uwe E. Reinhardt, Ph.D.
Last summer, Uwe E. Reinhardt, a health policy expert and economics professor at Princeton (and keynote speaker at Health Journalism 2009), predicted this would happen.
A contributor to the Economix blog for The New York Times, Reinhardt wrote, “In the arsenal now being assembled on the payment side of health care to address rising costs, reference pricing may well turn out to be the sleeper, because it is a potentially powerful method of ‘putting the patient’s skin in the game,’ the delicate phrase we use for ‘cost-sharing by patients.’”
Reference pricing is a sleeper no longer. It’s getting a lot of press lately and is the subject of a webinar at 1 p.m . ET today (see below for details).
It was mentioned in the big announcement from the Health Care Cost Institute (HCCI), which said on May 14 that it would work with three large health insurers to provide free consumer access to an online database of “the most accurate and timely information about the price and quality of health care services.” Starting early next year, HCCI said it will make price and quality data available from Aetna, Humana and UnitedHealthcare. Continue reading
Most health care price transparency efforts are aimed at giving patients more information on costs at the point of care. Armed with this information, consumers will shop comparatively just as they do for cars, computers and appliances, driving down prices, health policy experts say.
Now a report released today says that not only should patients have more information on the cost of care but physicians, employers and policymakers should get cost information too. If all these groups had more information on what care costs, the effect would be a reduction in health care spending of $100 billion over 10 years, according to an analysis done by researchers for the Gary and Mary West Health Policy Center.
Health care price transparency information is not widespread, although many organizations recognize the value of giving such data to patients to promote comparison shopping, said Joseph Smith, M.D., chairman of the West Health Policy Center Board of Directors. If more groups had such data, there would be more awareness among all, and thus the potential for more shopping and more savings. Continue reading
Image of glass by Tim Caynes via flickr.
It’s widely assumed that when patients have more information about the cost of care they drive down health care costs by voting with their feet. To date, this assumption has been just that: a theory.
In an attempt to address the debate, researchers will release an analysis from the West Health Policy Center on May 15 that estimates that more price transparency in health care could be a source of more than $100 billion in savings over 10 years. The potential for significant savings is intriguing, and the fact that the analysis comes from highly respected health care researchers is significant.
The researchers include Paul B. Ginsburg, Ph.D., the former president of the Center for Studying Health System Change (HSC) who is a professor at the University of Southern California, and Chapin White, Ph.D., a former senior researcher at HSC who is now at the RAND Corporation. Others working on the analysis include former HSC researchers who are now at Mathematica Policy Research: Kristie Liao, James D. Reschovsky, Ph.D., and Ha T. Tu. Another researcher contributing to the analysis is Joseph M. Smith, M.D., Ph.D., the chairman of the West Health Policy Center board of directors and chief medical and science officer of the West Health Institute. Continue reading
One of the biggest health care news stories of 2013 was the lack of price transparency. But consumers need much more than price information to know how to shop for health care services.
They need extensive information on the quality of care physicians, hospitals, and other providers deliver. Unfortunately, data on the quality that physicians and hospitals deliver are not as widespread or as robust as they need to be.
A recent report, “State Report Card on Transparency of Physician Quality Information,” from the Health Care Incentives Improvement Institute (HCI3) addresses the issue, saying:
“… finding information on the quality of physicians remains elusive for most consumers. While Medicare has a public web site that contains information on physicians, it is completely void of any data on the quality of care delivered. That’s all the more surprising since physicians have been reporting a basket of quality measures to Medicare for several years.
“There are commercial websites that provide some information on the quality of physician care, but there’s often a fee to pay for the full report, and the objectivity of the data on those sites has been questioned by many researchers.”