“There is no silver bullet to fix the health care system, but these are conversations that need to be had.”
to know where they are with their de- ductible and copayment. They want to know what their out-of-pocket expenses are. If patients are uninsured, posting an amount tells them nothing about any prompt-pay discount or other discounts they may be eligible for.” Nor does a health care price mean much if it is isolated from information on the quality of those services, she added. A recent study in the Journal of Con-
sumer Research showed patients also may misinterpret and misuse health care pric- ing information. Patients in the study translated lower prices for a particular medical service as a sign of greater ac- cessibility and therefore greater need for that care. The reverse was true with higher prices.
The findings suggest that consumers
What’s in a price? The discussions were prompted in part by the emergence of new benefit plans — so-called consumer-directed health plans — that offer lower monthly premi- ums with higher deductibles to incentiv- ize patients to more judiciously choose their care.
The higher out-of-pocket costs result- ed in some “sticker shock” to patients unaware of their obligations under such plans, says Houston family physician Patrick M. Carter, MD. The TMA Coun- cil on Legislation member and chief of family medicine at Kelsey-Seybold Clinic also serves on the institute board. One possible solution posed to the institute was to publicly reveal the amounts physicians and hospitals “ac- cept as payment in full” for a particular service. That would include any negoti- ated discounts from their original billed charge, combined with a requirement to adhere to those prices.
Patrick Carter, MD
Physicians and other institute members agreed that improving pa- tients’ ability to as- sess their financial responsibilities be- fore receiving care “is an important dimension of price transparency.”
36 TEXAS MEDICINE March 2013
But so many factors go into the cost of medical services they would not fit on a typical price tag, Dr. Carter says. Nor would such information be meaningful to patients or feasible for physicians to share.
Doctors do have a set price, or billed
charge, for a basic office visit. Before evaluating a patient, however, there’s no way to predict his or her combination of symptoms or the kind of testing and treatment needed to respond. “And the next visit could be totally
different,” he said, making it difficult to follow a fixed price, even if one could be set. “The number of things I as a family doctor could decide to do runs into the thousands for each visit.” That’s just step one. The billed charge does not take into account the fact that physicians individ- ually negotiate different rates with dif- ferent health insurers based on a host of factors, like the number of patients in a particular plan. And insurers themselves have scores of different products. “So even if my rate is the same for two patients, those patients might have dif- ferent benefit plans,” Dr. Carter said. If physicians were to somehow ex- plain all that by posting a single price, it still wouldn’t tell patients what they really want to know, says Dr. Strate, vice speaker of the TMA House of Delegates. “If patients have insurance, they want
“make inconsistent assumptions about risk, prevalence, and need with price ex- posure.” And, “while greater price trans- parency may indeed reduce consumption of higher-priced goods, it may do so for both necessary and unnecessary care,” researchers concluded in their report, “Price Inferences for Sacred Versus Secu- lar Goods: Changing the Price of Medi- cine Influences Perceived Health Risk.” Dr. Strate adds that even if doctors
could research all the various treatment options, CPT codes, and insurance sce- narios to come up with such a price in advance — a near impossibility adminis- tratively for physician practices to do, let alone for patients to understand — phy- sicians don’t always have access to all of the benefits and pricing information patients would need. Health plans do, however, and much of it is already available to patients, the institute found. Instead of posting health care prices, the board said transparency could be achieved in other ways.
Seeking transparency Members recommended implementing and enhancing existing transparency ini- tiatives that encourage a wide range of players — physicians, hospitals, payers, employers, and consumer groups — to make quality and cost information more widely available and that encourage pa- tients to seek it.
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