Prices hard to come by in Mass. de­spite trans­parency law

Modern Healthcare - - REGIONAL NEWS - —Me­lanie Evans

House­holds may find med­i­cal bills ab­sorb an in­creas­ing share of their in­come. But as con­sumers, their abil­ity to shop among hos­pi­tals and clin­ics re­mains lim­ited.

For more than a year, Mas­sachusetts hos­pi­tals and clin­ics have been re­quired to re­spond within two busi­ness days to con­sumers’ re­quest for a price. That has proved dif­fi­cult for some hos­pi­tals in the state sur­veyed by the public pol­icy think tank Pi­o­neer In­sti­tute. It sur­veyed 22 hos­pi­tals and 10 clin­ics on the price of a com­mon and un­com­pli­cated imag­ing ser­vice, an MRI with­out con­trast.

Many hos­pi­tals could not quote a price within two days. Clin­ics fared much bet­ter. But both re­sults did not shock na­tional or­ga­ni­za­tions that ad­vo­cate for more price trans­parency.

“Gen­er­ally, most states have very few laws that truly en­sure that cit­i­zens have ac­cess to price in­for­ma­tion,” said Suzanne Del­banco, ex­ec­u­tive di­rec­tor of Cat­a­lyst for Pay­ment Re­form, which will re­lease its third sur­vey of state price trans­parency ef­forts this sum­mer.

Mas­sachusetts’ price law, one pro­vi­sion of the state’s broader 2012 statute to man­age health spend­ing, re­quires hos­pi­tals, clin­ics and health in­sur­ers to quote a price or es­ti­mate be­fore pa­tients re­ceive care.

Hos­pi­tals strug­gle to do so for mul­ti­ple rea­sons, said Del­banco and other trans­parency ad­vo­cates. One pro­ce­dure can com­bine bills from mul­ti­ple sources: hos­pi­tals, doc­tors, lab­o­ra­to­ries and imag­ing cen­ters. Among those with in­sur­ance, the amount pa­tients will pay de­pends on rates ne­go­ti­ated by their in­sur­ance com­pany and health plan de­ductibles or other out-of-pocket costs.

“Price is a neb­u­lous thing in healthcare,” said Steve Wo­j­cik, a vice pres­i­dent at the Na­tional Busi­ness Group on Health, which rep­re­sents large em­ploy­ers.


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