Ohio Academy of Family Physicians President Tom Houston, MD, submitted the following response to The Columbus Dispatch editorial published on March 3 regarding price transparency:
“The March 3 Dispatch editorial, ‘Shed Light on Medical Bills,’ discusses the need for increased price transparency relative to medical charges. I think most everyone agrees with this general premise – patients should know what is going to be billed for services provided, what portion their insurance company covers, and exactly what costs are the responsibility of the patient.
The lack of price transparency makes it difficult for patients to comparison shop. Physicians, too, don’t necessarily know where to refer patients for most cost effective testing, for example, when a less expensive option might work just as well.
The question is how best to make this information available. The legislative mandate inserted into the enacted state workers’ compensation budget bill is not a feasible, practical, or workable solution. Under provisions of this mandate, your physician would have to tell you prior to the beginning of your appointment what you would be billed, what your insurance company would pay, and what your actual cost responsibility would be. So, your physician will have to decide what you will be charged prior to having examined you or made any kind of diagnosis – kind of like your car mechanic guaranteeing to fix your car before looking to see what might be wrong with it. And even if that were possible (and it’s not), the physician would have to navigate, interpret, and verify the insurance coverage contract of every patient who walked in the door, for every lab test, X-ray, or procedure to provide the required information – this in primary care practices that are already drowning in insurance company mandates, prior authorization requests, and other administrative burdens. Physicians have no way to obtain this level of detail from each patient’s insurance company while the patient waits in the office for an answer.
Improved price transparency is a laudable, much needed objective, but we should not impose impractical and unfeasible mandates on physician offices – mandates that are completely impossible to implement in today’s convoluted health care environment. While the current provision is likely well-intentioned, it is not a viable way to achieve increased price transparency.”
In a related matter, the U.S. Supreme Court issued a decision on March 1 that could substantially impact Ohio’s prices transparency initiative. Read the related article “Supreme Court Ruling a Blow to All-Payer Claims Databases.”