LEGISLATIVE AFFAIRS
Lifting the veil Price transparency efforts target physicians
BY AMY LYNN SORREL As govern- ments and employers look for ways to curb growing health care costs, and as patients bear a higher share of their medical bills, policymakers in Texas and beyond increasingly target phy- sicians in their efforts to unveil health care prices. They couch such “price transparency” as a way to help patients make more informed health care decisions. But Texas Medical Associa-
tion’s Board of Trustees mem- ber Gary W. Floyd, MD, of Fort Worth, cautions that for a com- plex health care payment system, coupled with individual patients’ complex needs, coming up with a so-called “sticker price” is not as simple as it seems. Gone are the days of his prac- tice in 1980s’ Oklahoma, when the pediatrician simply charged $12 for a new patient visit and $8 for a follow-up visit. “I dealt with my patients, and my pa- tients dealt with their insurance company.” Flash forward to a time when myriad insurance regu- lations, contract rates, deduct-
formed a workgroup focused on price transparency. But TMA is poised to make sure that any approaches to transparency are meaningful for patients and fea- sible for physicians, Dr. Floyd says. “Our goal is to lead the discussion. But the bottom line is, it has to be patient-centered.” The discussion has captured state capitols across the country, and TMA expects it to resurface during Texas’ 2015 legislative session.
Lawmakers are likely to pick
up where they left off after in- troducing measures during the 2013 legislature that aimed to have physicians publicly post prices for their services. In February, Lt. Gov. David
TMA’s price transparency workgroup is vigilant that any legislative approaches are meaningful for patients and feasible for physicians, says Gary W. Floyd, MD. “Our goal is to lead the discussion. But the bottom line is, it has to be patient-centered.”
ibles, and CPT codes — not to mention any combination of patient conditions — increasingly cloud those numbers. Dr. Floyd acknowledges that even he has a hard time divining what his patients’ costs are today. Helping patients assess their financial responsibilities before
receiving care is an important part of transparency, and physi- cians can play a role in unshrouding that seeming mystery, he says. “But this is new territory, and this is far more complex than anyone’s imagined.” To help find a solution, TMA’s Council on Legislation
Dewhurst announced interim charges that task the Senate State Affairs Committee with studying and making recom- mendations on increasing medical price transparency in Texas. And the Texas Institute for Health Care Quality and Effi- ciency (IHCQE), which the 2011 legislature created under Senate Bill 7 (the state’s own version of
health system reform), continues to study the issue. Lawmakers say that transparency is likely here to stay, and physicians are key players.
Finding the right approach Sen. Charles Schwertner, MD (R-Georgetown), says price dis- closures have the potential to rein in costs and increase com- petition in health care — if done right. The orthopedic surgeon pointed to Medicare’s unprecedented release in April of physi- cian payments as an example of what could go wrong, how-
July 2014 TEXAS MEDICINE 37
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