On April 26, the House Services Price Disclosure Study Committee met to hear concerns with a provision inserted into the Ohio Bureau of Workers Compensation budget bill last year that would require physicians and other health care professionals to offer, upon request, a good-faith cost estimate for all non-emergency services.
Greg Moody, director of the Governor’s Office of Health Transformation, testified before the committee stating there are questions about the feasibility of the mandate. And while the Ohio Department of Medicaid and stakeholders remain seriously concerned about the feasibility of implementing the mandate, Medicaid must start drafting rules soon in order to meet the Friday, July 1, deadline for implementing rules effective Sunday, January 1, 2017.
The biggest difficulty with implementation is the broad scope of the mandate. The mandate was added to the workers compensation budget bill at the eleventh hour and therefore was not thoroughly reviewed in the legislative hearing process. As a result, there was no opportunity to identify and discuss feasibility problems.
In addition, even the logistics of the rule writing process are confusing. The Office of Health Transformation does not have rule-making authority. Medicaid has traditional authority over Medicaid managed care plan rule-making and the Ohio Department of Insurance has authority to create rules for commercial health care plans operating in the state. The State Medical Board of Ohio, the State of Ohio Board of Pharmacy, and the Ohio Board of Nursing regulate their licensees. Nevertheless, the Ohio Department of Medicaid was identified in the statute to write the rules even though the law covers a group far broader than it has authority over.
Medicaid Director John McCarthy testified that cost is another major factor. Considering that necessary data changes to implement a rule could cost millions, taking rules to the Common Sense Initiative for review would likely be met with distain.
Bottom line, to those most impacted by these rules (physicians, hospitals, insurers, and patients), much additional work needs to occur before any type of price transparency mandate is implemented. Timelines, anticipated costs, and feasibility concerns make enactment of corrective legislation advisable.
The Ohio Academy of Family Physicians has joined other physician organizations in advocating for revisions to this unworkable mandate and would welcome the opportunity to work with legislators on a fix. While the requirement’s intent sounds good in theory, the requirement, as currently constructed, is difficult, if not impossible, to implement. Officials from the Kasich Administration agree that implementation is not feasible.
View the letter to the editor written by OAFP President Tom Houston, MD, on this topic.