Patients could know the price of more medical procedures before receiving treatment if a bipartisan bill on health care transparency makes it through the Wisconsin Legislature.
Analysts say the bill will help consumers, boost quality, and lower prices.
Senate Bill 337 would require health care providers to list prices for their 50 most commonly provided services. The list would be made available free of charge in spreadsheet form to any consumer who requested it.
It would break down charges into three categories: retail (or “usual and customary” charge, the amount an uninsured person would be charged), Medicaid reimbursement, and the average amount an insured patient pays.
Additionally, insurance companies would be required to provide policyholders with information about their allowable payment for procedures, upon request and for free, so consumers could better estimate how much they must pay before having a medical procedure.
Nicole Hudzinski, legislative aide to state Sen. Jim Sullivan (D-Wauwatosa), the bill’s sponsor, said the measure would help educate consumers about the cost of their health care and equip them with the tools to make informed decisions.
State Rep. Steve Wieckert (R-Appleton) agreed, saying the bill would empower consumers to make intelligent choices about their health care–a tough task when they don’t have enough information.
“There are so many people who want to be responsible, but they don’t know,” Wieckert said. “It’s hard to figure out how much health care costs. There are cheaper places to get it done, but medical pricing right now is like a big black box, and nobody knows.”
An example of this, said Wieckert, is hand surgery, which several Wisconsin clinics perform. For a certain procedure, one clinic charges almost $3,000, and another charges about $1,800–but a third clinic, which specializes in it, charges less than $1,000. Having access to information like this would greatly benefit patients, Wieckert points out.
Wild Price Variations Common
According to Wieckert, the hand clinic example is not an isolated phenomenon. He said clinics that specialize in a specific type of medical treatment often offer consumers better quality and pricing.
Hudzinski noted the bill would help free the market by forcing providers to compete for customers.
“Hopefully like in other markets, when consumers start to shop around, [providers] are going to have to bring their prices down if they want to continue to have patients,” Hudzinski said.
‘Wait and See’ Attitude
The proposal has raised a few concerns among some providers.
Dr. Carl Eisenberg, a pediatrician and chairman of the Wisconsin Medical Society’s Council on Legislation, said although he has no personal difficulties with the bill, some members of his council worry about providing accurate prices because health care costs are difficult to estimate.
“It’s one thing for a physician in his or her office to publish what the charges are,” Eisenberg said. “Sometimes, though, it’s difficult to know until the patient arrives what level of service will correspond with a certain complaint.”
For example, a patient calling for the cost of a visit for his child’s earache may not understand the cost could vary with the severity of the condition because the treatment would differ. Doctors may not be able to provide an accurate prediction, Eisenberg said.
According to Wieckert, though, health care administrators generally have declined to fight against the bill, perhaps because legislators from both parties have worked very hard to make the measure compatible with their needs.
“Some people are taking a ‘wait and see’ attitude while others were a little concerned about the additional paperwork,” said Wieckert. “I think people realize this needs to happen.”
Jillian Melchior ([email protected]) writes from Michigan.
For more information …
Wisconsin Senate Bill 337: http://www.legis.state.wi.us/2007/data/SB-337.pdf