On December 23, 2016, Judge J. T. Stelzer of the Williams County Common Pleas Court issued a restraining order preventing Ohio’s price transparency law from going into effect. The court has scheduled a hearing for Friday, January 20, to decide whether to issue a preliminary injunction.
As was reported in the December 20, 2016, edition of the Weekly Family Medicine Update (WFMU), all physician and other health care organizations have stated “loudly and clearly” that the price transparency statute that went into effective on January 1 is unworkable and impossible to implement. The report of the Health Services Price Disclosure Study Committee is still unwritten and the rules to implement the statute are not promulgated. Fortunately, the statute contains no penalties for failing to adhere to the law.
The intent of the legislation is to require providers of health care services to offer, upon request, a good-faith cost estimate for all non-emergency services. Legislators see the need for improved health care price transparency, but don’t necessarily understand how complex and difficult it is to make it happen.
Negotiations relative to how to amend the law to make it workable have been occurring for over a year with no agreed upon outcome to date; thus, the need for filing of the lawsuit requesting a temporary restraining order.
In a letter to the editor published by The Columbus Dispatch in March 2016, then Ohio Academy of Family Physicians President Tom Houston, MD, wrote:
The March 3, 2016 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. This legislative mandate 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 is 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.
Watch the WFMU for continuing developments on this issue.