New law to require health care providers to list prices

AUGUSTA — For years, most patients have received medical procedures without knowing the cost. Want to know how much you’ll shell out for that X-ray or CT scan? Many would simply wait for the bill.

But starting in 2014, practitioners in Maine will be required to compile a list of their most commonly performed procedures — anything done more than 50 times per year — and the price that would be paid by an uninsured patient. Practitioners, from chiropractors to hospital internists, must inform patients about the availability of the list and provide copies upon request.

An Act to Require Public Disclosure of Health Care Prices, a bill by Sen. Dick Woodbury, I-Yarmouth, passed during the last legislative session and was signed into law by Gov. Paul LePage. The bill replaced an older law that simply required the posting of prices.

That effort was never really followed, said Gordon Smith, executive vice president of the Maine Medical Association, by phone Tuesday.

“We did some education with our members at that time, but in all honesty, over a period of 10 years, it wasn’t observed,” he said.

While organizations similar to his in other states, such as Arizona, have opposed such transparency measures, Smith said MMA supported the aim of Woodbury’s bill.

“People, ethically, are entitled to know,” he said. “For 60 or 70 years, we relied so much on third-party payment that people just got away from needing or wanting to know the price of something. But there are people who are going to be paying cash, whether they are uninsured or carry a big deductible.”

Still, Smith is working with Woodbury and the Maine Hospital Association to amend the law. Another bill by Woodbury, accepted into the truncated second legislative session, will be the vehicle for those amendments. Efforts to contact Woodbury on Tuesday were unsuccessful.

One of the provisions the trio hope to change is the requirement that practitioners provide complete lists of all services conducted more than 50 times annually.

Jeff Austin, lobbyist for MHA, said such a comprehensive list would include a lot of information that one patient wouldn’t need, and could risk overwhelming someone in the vulnerable position of being uninsured and needing medical care.

“The goal is to get people information about their own care,” he said. “If you’re going to get your tonsils out, you don’t need to see the price of back surgery. The codes associated with your own care are more to the patient than a list of codes that have nothing to do with their care. We don’t want to confuse people.”

Smith and Austin also said that a component in the law that requires diagnostic codes be included in any list given to patients should be changed to instead require the more commonly used “current procedural technology,” or CPT, code.

Lastly, the law may be amended to change the word “practitioner” to something more broad, such as “practice sites.” That’s because a single hospital or other medical facility may employ several professionals who all perform the same procedures. In that case, the cost is the same, no matter who provides the service.

That amendment is more a matter of legal clean-up than anything else, Austin said. The original law “didn’t intend us to have several hundred lists when you enter the door,” he said.

The state is also home to the Maine Health Data Organization, an agency funded by insurance companies and hospitals that compiles an “All Payer Claims” database — basically a master list of how much different medical procedures cost, broken out by provider and insurance company.

The data would be available for sale to research companies or the like, but MHDO was also required to list data for the public benefit.

Austin said MHDO had so far “not operated as we’d hoped,” but was encouraged by new leadership at the agency. He said there had been vast improvements in the last year.

The transparency law requires practitioners not only to provide their own price lists, but to direct patients to MHDO for additional information. Ideally, practitioner lists and MHDO data will work in concert toward that end without being redundant, Austin said.

The ultimate goal is for patients to be educated enough that they can find the best deal for any planned medical procedure. Smith said that changing the medical culture — for patients and doctors alike — so that price is more transparent, would be crucial in addressing the constant rise of health care costs.

“You can’t really get a good handle on reducing costs unless people are paying more attention to it,” he said.

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Comments

AL PELLETIER's picture

It's about time.

Three years ago I was scheduled for a minor hernia operation but a week prior I called the hospital to find out how much it would cost me and my insurance company.
The billing dept. had no idea, as my request was a bit unusual, and it was as if I was putting them through hoops to give me an answer. With my insistence, they called me the next day and said it would be $18,000.00 plus the anesthesiologist.
My out of pocket would have been the $6,000.00 deductible plus a 20% co-pay making my share $8,400.00+.
As I was only 6 months away from going on Medicare guess what I did?

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