“Most patients only really care about what they are going to pay out of pocket, and that’s very much dependent on health plans and employers, not physicians.”
to 45 states, including Texas (http://bit .ly/StateTransparency).
When it comes to price transparen-
cy, “every other industry has figured it out,” HCI3 Executive Director Francois de Brantes said. “Health care needs to figure it out.”
Price check? But health care is not exactly like every other industry, says Patrick Carter, MD. The TMA Council on Legislation member and chief of family medicine at Kelsey- Seybold Clinic in Houston also serves on the IHCQE Board of Directors. Physicians do have a set price for dif-
ferent services, known as their billed charge. (See “Know Your Price,” page 41.) “And posting the billed charge is not really a problem for most physicians,” he said. “The problem is almost nobody pays the billed charge, so it’s not going to be meaningful for most patients.” That’s because the billed charge does
ever. (See “Medicare Discloses Physician Payments,” opposite page.) “There’s a distortion there that’s not
fully or easily understood by the general public,” he said. For example, patients may see large payment amounts attrib- uted to a single physician, but that phy- sician’s name may represent a large prac- tice that employs other doctors, nurses, and physician assistants and that spends a significant amount of money up front on cancer drugs for their patients. When it comes to pricing, “it could get even more distorted if we just looked at one piece,” such as physician billed charges, Senator Schwertner said. “Phy- sicians can lead on this issue, and we shouldn’t be afraid to lead on it. But if we [the state] take steps toward trans- parency, we must include all health care providers. And we need to move forward in a way that does not misrepresent to the public what health care pricing is all about. We do a disservice to our patients if we put forth information that is not full and complete.” Rep. Greg Bonnen, MD (R-Friends- wood), whose bills sparked the conversa- tion last session, says finding a solution may not be easy, but it is forthcoming. And physicians can help shape it.
38 TEXAS MEDICINE July 2014 “This is not transparency for transpar-
ency’s sake. This is motivated by an ef- fort to understand where this money is going and why it’s costing so much. Ulti- mately, there is going to be either a gov- ernment-driven solution for this or a pa- tient-driven solution, and we are better off with a patient-driven solution. And if patients are going to be empowered to make good choices financially, that means they are going to have to have an accurate understanding of what [care] they are going to receive, how much it’s going to cost, and a vested interest in those decisions,” he said. “The flip side is, if we [physicians] are not engaged and responsible in our allocation of re- sources and in empowering our patients to make good choices, what we end up with is out-of-control costs and a quarter of our state uninsured.” A recent report card from a pair of consumer advocacy organizations sug- gests the Lone Star State and the rest of the country have a long way to go to provide patients with meaningful price information. In their 2014 “Report Card on State Price Transparency Laws,” the Health Care Incentives Improvement In- stitute (HCI3) and the Catalyst for Pay- ment Reform handed out failing grades
not take into account the fact that phy- sicians individually negotiate different rates with different health insurers based on a host of factors, such as the number of patients in a particular plan. And be- cause no two plans are alike, neither are patients’ costs, even if Dr. Carter’s fee is the same.
Contracted rates are a different issue.
“And physicians, like any other busi- ness, have the right to privately nego- tiate the best rates they can,” he said. Opening up that information would not only confuse patients but “significantly change the way physicians do business.” Health plans also have objected to the idea because they consider that in- formation to be proprietary, although insurers and physicians can share the information with individual enrollees or other parties to the contract. Yet another barrier to posting mean- ingful health care prices, however, is that just like health plans, no two pa- tients are alike, Dr. Carter says. “In the course of providing care, as physicians, we build [a treatment plan] as we go along. When I see a patient in my office, I don’t know what I’m going to wind up ordering or needing.”
Nor is it administratively simple, giv- en the hundreds of CPT codes for physi-
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