[F]acing a controversial proposal to improve medical billing transparency, Vermont’s senators are seeking some help.
The Senate on Wednesday gave preliminary approval to S.31, a bill that originally said patients should get more information about prices for elective procedures, facility fees and potential conflicts of interest.
But that language was deleted after hospitals and physicians complained that the bill was too burdensome and wouldn’t work as intended. Instead, the legislation now orders a Green Mountain Care Board study of “transparency initiatives in other states” that might also work in Vermont.
“I think we all agree there’s a problem” with complex medical billing, said Sen. Ann Cummings, D-Washington. “It’s just that the solution is not as simple as one would think.”
Sen. Chris Pearson, P/D-Chittenden and the sponsor of S.31, said he wishes the amended bill was stronger but understands that reforming the system is difficult.
“It should definitely not be this hard. (But) it is complicated,” Pearson said. “You have big, powerful players up against a part-time citizen Legislature.”
In introducing his bill to the Senate Health and Welfare Committee earlier this session, Pearson said patients “should not be bombarded with confusing paperwork that seems to be contradictory at every turn” after they receive medical care.
Pearson also had argued that patients “deserve some example ahead of time of what the cost might be, so they can make informed choices.”
Pearson’s bill as initially written would not have fully addressed those issues. But it did say consumers have “the right to see a price list for elective procedures and to be informed of less expensive options if they are available.” Patients also would have been told in advance about facility fees connected to the place where a health care service is being offered.
Additionally, the legislation had said patients should know 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 also featured new requirements for insurers, which didn’t cause much of a stir. But both the Vermont Association of Hospitals and Health Systems and the Vermont Medical Society took issue with the bill.
In testimony submitted to Senate Health and Welfare, the hospital association said “no one institution or organization has all the pieces of the (billing) puzzle.”
“To truly tackle the issue of transparency in billing, hospitals, independent providers, health insurers and consumers must come together to craft a solution,” the association said.
Senate Health and Welfare’s amended version of the bill does say patients have the right to see information about health care prices, financial assistance and “billing and collections practices.” But it doesn’t have any specific provisions ordering medical providers to hand over such information.
Rather, the bill says Green Mountain Care Board should “examine health care price transparency initiatives in other states to identify possible options for making applicable health care pricing information readily available to consumers” in Vermont.
Also, the bill says the care board should consider “potential financial procedures for health care services that would coordinate processes between hospitals and payers without requiring the patient’s involvement and would provide patients who receive hospital services with a single, comprehensive bill that reflects the patient’s entire, actual financial obligation.”
The board’s report would be due by Nov. 15.
Speaking on the Senate floor Wednesday, Cummings acknowledged that senators “kicked the can down the road” by ordering a study of health care billing. But she also said that, every time lawmakers proposed a potential solution for the system, “it got to be very expensive, and we’re not sure it was any clearer.”
“We have created a very complicated system of health care,” Cummings said. “And we therefore have a very complicated system of billing – some of it under our control, some of it not under our control.”
The bill still is subject to one more Senate vote and then goes to the House, where it could be amended further or restored to its original intent. But some wonder whether medical costs can be simplified to the extent that some consumers desire.
“I don’t think there’s anything clear or transparent about medical billing, and I’m not sure there ever will be,” said Sen. Jeanette White, D-Windham.
Despite his disappointment with some aspects of the newly amended version of S.31, Pearson also said he thinks the care board’s transparency study will “give us some useful information” for further legislative action.
“I think there’s been a great public response to this discussion, and I personally am committed to keeping after it,” Pearson said.
