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HealthCare Checkup

The Seattle Times health-care team tracks the local impact of the Affordable Care Act.

February 3, 2014 at 11:22 AM

How to avoid medical bill surprises

Healthcare BluebookNo one wants to buy a sweater, rent a car or order a bottle of wine with almost no idea what it will cost or how good it will be. Yet for the most part that’s how we buy our health care, with little idea of its cost or quality ahead of time. And consumers are often surprised to learn that health care can be many times more expensive at one facility compared to another.

That could change soon in Washington. Officials here are eager to shine some light on the price of health care in an effort to rein in medical costs, as I reported on Sunday. But if you’re shopping for care now, there are some tools available to help consumers make informed decisions.

If you have health insurance, chances are your insurance company has a cost comparison tool on their website, though they can be hard to find. Once you log into your insurer’s site, look for the cost tool or a tool that lets you search for a doctor. Cost and quality information are sometimes paired with the doctor search.

A national site called Healthcare Bluebook lets you search for a “fair price” for services in your area. It also gives suggestions for how to request price information and negotiate costs with your local hospitals and clinics.

When it comes to measuring the quality of care, the Washington Health Alliance (formerly Puget Sound Health Alliance) for many years has surveyed and published information about the performance of hospitals and clinics through its Community Checkup website. The national Leapfrog Group also publishes information about hospital safety.

But none of these options perfectly wed easy-to-search cost and quality information available with the public, regardless of whether they’re insured and who insures them.

State leaders are trying to change that, and one avenue is through new rules being proposed in Olympia.
House Bill 2572 is the more ambitious of the bills proposed so far. The legislation would create a statewide database that includes the cost of medical procedures at hospitals and clinics, and information about the quality and performance of the facilities. Insurance companies would be required to disclose how much they are paying for medical services at these different sites. The bill also will improve the way we measure the quality of health care. The database — called an All-Payer Claims Database — would be available to the public.

HB 2572 was requested by Gov. Jay Inslee and is being sponsored by Rep. Eileen Cody, a Democrat from West Seattle and chair of the House Health Care and Wellness Committee. The bill has already had a committee hearing, where representatives from the Washington State Hospital Association, Washington State Medical Association, Seattle Metropolitan Chamber of Commerce and the National Federation of Independent Business all testified in support of it.

Officials with Premera Blue Cross and Regence Blue Shield oppose the legislation. Insurance companies negotiate the rates that they pay hospitals and doctors, and that information is considered proprietary. Company officials say they worry about losing  competitive advantage if they share this information.

At least 11 states have these databases and many others are pursuing them.

“Once you have a database in place, everyone has opened their kimonos,” said Bob Crittenden, health-care policy guru for Inslee. “You can make more progress. Everyone agrees there should be more data for consumers, but it’s always somebody else’s information they want to see.”

There’s another piece of legislation being considered, Senate Bill 6228. The proposed law would require insurance companies to offer online cost and quality comparison tools for their customers, and it describes what features the tools must include. The state Office of the Insurance Commissioner would review the cost tools for companies selling or renewing plans in the state beginning in 2016.

Regardless of what happens in Olympia, health-care leaders are already taking steps toward greater transparency.

Last year, the state won a $1 million grant from the federal Center for Medicare and Medicaid Innovation to create a five-year plan for improving health care in the state. In December, officials released a 110-page Washington State Health Care Innovation Plan, which includes strategies for improving transparency.

Mary Kay Clunies Ross, vice president of communications with the Washington State Hospital Association, said her organization sees the creation of cost and quality database as “inevitable” and is eager to participate in the process.

“Our state will end up with a very good product to help people make choices,” she said, “and create a system of information gathering that feeds that triple aim of improving the patient experience.”




Comments | Topics: Affordable Care Act, All-Payer Claims Database, health insurance


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