Price Transparency
Hospital price transparency is a crucial first step towards reining in skyrocketing health care expenses. But transparency alone is not enough.
If hospitals publish estimates instead of actual prices, patients can be in for a rude awakening once the bill arrives. That’s what happened to a man in Ohio after he received an unexpected $76,000 bill that forced him into bankruptcy.
In order to make informed decisions, Texans need actual prices not estimates.
Quality Transparency
Chapter 1460 of the Texas Insurance Code currently prohibits a health benefit plan issuer, including a subsidiary or affiliate, from ranking physicians, classifying physicians into tiers based on performance, or publishing physician-specific information that includes rankings, tiers, ratings, or other comparisons of a physician’s performance against standards, measures, or other physicians without undertaking a burdensome process that includes allowing physicians an extended opportunity to dispute the ranking or classification.
In effect, this bars health benefit plans from informing patients where they can find the best care for their money.
Texans deserve quality transparency so that employers can design intelligent benefit plans and patients can make informed decisions about their care.
Honest Billing
Too often patients are going to their doctor’s office and getting a bill for hospital care.
That’s what happened to a Houston mother who took her kids to the doctor and received a bill for a $290 charge labeled “observation/treatment room,” and another fee of $405 for a “room, staff and supply charge.”
Patients should only be billed for the care they received at the location where they received it. That’s honest billing.
The Center on Health Insurance Reforms at the McCourt School of Public Policy at Georgetown University is tracking strategies to reform outpatient facility fee billing in all 50 states and the District of Columbia. Hover over each state for detailed information, and visit the Center on Health Insurance Reforms to learn more.
Overall Picture of State Outpatient Facility Fee Billing Reforms for the Commercial Health Insurance Market
All-Payer Claims Database
One of the biggest problems in health care economics is price variation. The same service can cost up to ten times more based on who is paying or where the service is delivered.
An All-Payer Claims Database (APCD) can provide researchers with real data essential to identifying market inefficiencies and help employers make informed decisions about how to reduce health care costs.