[S]tate lawmakers are considering a bill designed to improve health care price transparency, but groups representing Vermont’s hospitals and physicians contend it could have the opposite effect.
S.31 mandates that hospitals and doctors provide new disclosures including prices for elective procedures, facility fees and potential conflicts of interest. Failure to comply could carry licensure implications.
Both the Vermont Association of Hospitals and Health Systems and the Vermont Medical Society are raising concerns about the bill, saying it’s unlikely to resolve consumer confusion.
“What it does is, it requires hospitals and physicians to provide patients with more paperwork,” said Devon Green, the hospital association’s vice president of government relations.
But supporters say any improvement in the system would be welcome. “All we’re asking is that we arm Vermonters with more information,” David Mickenberg, representing AARP Vermont, told lawmakers on Friday.
S.31 was introduced by state Sen. Chris Pearson, P/D-Chittenden. In recent testimony before the Senate Health and Welfare Committee, Pearson said the idea was generated by a New York Times opinion piece about strengthening patients’ rights.
Patients “should not be bombarded with confusing paperwork that seems to be contradictory at every turn,” Pearson said.
“They deserve some clarity, they deserve some ability to open one piece of mail and understand what the billing’s going to be,” he told the committee. “Ideally, they deserve some example ahead of time of what the cost might be, so they can make informed choices.”
S.31 amends Vermont’s patient bill of rights to say a consumer has “the right to see a price list for elective procedures and to be informed of less expensive options if they are available.” Patients also must be informed in advance about facility fees connected to the place where a health care service is being offered.
Patients should hear about “any potential conflicts of interest that a physician or hospital may have in a test, surgery, procedure or other health care service” before that service is performed, the bill says. That information should include “any financial stake” that a doctor has in a health care facility where a procedure is taking place.
The bill also has new requirements for insurers, including updated lists of providers in their network and a guarantee that patients who receive emergency care outside the network won’t face greater out-of-pocket costs.
Representatives of MVP Health Care and Blue Cross and Blue Shield of Vermont said they have no major problems with S.31, mostly because it adheres to current policies.
But hospitals are worried.
That’s in part because a list of procedure charges bears little relation to what a patient will pay due to wide variations in insurance coverage and agreements between hospitals and insurers. That also was the knock on recently enacted federal requirements for hospital price disclosure.
“This is why it’s hard for the physician to sit down with a patient and say, ‘Here’s how much this is going to cost you, and here are the other options,’” Green said.
The hospital association also took issue with facility fee disclosures and the bill’s requirement that patients should “know if a disputed bill will be sent to a collection agency.”
“We don’t know from the outset if their bill is going to be going to a collection agency,” Green said. “We work with them first.”
Green acknowledged that “the health care billing system is confusing and stressful and less than transparent, and we definitely support streamlining this and greater transparency for Vermonters.”
“I just question whether (S.31) actually gets to the goal that we all want to get at … I wonder if it would be better to have a more targeted response,” she said.
Medical society Executive Director Jessa Barnard raised similar objections.
“Physicians do support sharing the cost of their own professional services,” Barnard said. “I think our concern with the bill is that it goes beyond information that the physician has access to.”
For example, she said a doctor might not know about “less expensive options provided at other locations,” and he or she might not “have routine access to information regarding facility fees.”
But Mickenberg argued that such objections don’t take into account the financial risk health care consumers face on a regular basis.
While a recent state survey found a low uninsured rate in Vermont, it also said 36 percent of Vermonters under age 65 are underinsured – meaning they don’t have insurance policies that can adequately cover their needs based on their income.
“When consumers face $5,000 deductibles, not having information about what they’re ultimately going to be paying has devastating consequences,” Mickenberg said.
Patients aren’t considering prices in emergency care situations, but advocates say that still leaves plenty of room for better cost transparency in other cases. “Once (patients) are told about different pricing, it will affect their decision-making,” Mickenberg said.
Sen. Ginny Lyons, D-Chittenden and chair of Senate Health and Welfare, said the bill “isn’t close to being finished.”
“We want to sort out, how can we make the pricing piece more transparent to patients,” Lyons said.
