Connecticut fails in providing health prices
Published 12:11 pm, Sunday, July 28, 2013
When it comes to letting people know how much they're paying for surgeries and other medical procedures, Connecticut gets failing grades.
That's according to the recently released "Report Card on State Price Transparency Laws," published by two nonprofits, including the Newtown-based Health Care Incentive Improvement Institute.
Connecticut was among 29 states to earn an "F" from health advocates for lacking consumer-friendly laws that help residents compare actual prices for health care procedures and services.
"There is no public resource in Connecticut that makes (comparison) pricing information available to consumers," said Francois de Brantes, executive director of the Health Care Incentive Improvement Institute. "That means there's no consumer protection against egregious pricing behaviors by providers."
The institute partnered with the nonprofit Catalyst for Payment Reform to publish the report card.
The card's scores reflected a state's overall legislative effort toward health care price transparency, with states that post price information on a public website receiving more points than those that release a report or provide data to consumers only upon request.
More InformationBy the numbers
Want data on how much your hospital charges for medical services? Right now, your best bet is to look at Centers for Medicare & Medicaid Services report on the prices hospitals charge Medicare.
However, glance with caution -- some critics said the numbers often don't represent the price consumers actually pay for these services and, in some cases, can cause more confusion than clarity.
If you're interested in seeing how much your hospital charges Medicare for joint replacement surgeries and the like, you can visit http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html.
The organizations that developed the report card are nonprofits that support payment reforms to increase the quality and value of health care.
Connecticut's failing grade isn't a surprise, said Ellen Andrews, executive director of the Connecticut Health Policy Project, a nonprofit, nonpartisan research and educational organization that works to improve access to health care in the state.
Andrews said consumers are often told to shop around for health care, but a lack of pricing resources makes that task difficult.
"The score is totally warranted," Andrews said. "Our state laws have been really behind when it comes to price transparency. We get calls from people on our hotline about this issue all the time."
Only two states -- Massachusetts and New Hampshire -- received an "A" on the report card.
Both states have all-payer claims databases, which systematically collect and aggregate claims from commercial insurers and the public insurers Medicare and Medicaid to give consumers an accurate idea of what services cost.
Connecticut is working to establish a claims database by next year.
For now, consumers can find some cost information by checking the Centers for Medicare & Medicaid Services report on the prices hospitals charge Medicare. But that report raised questions about how hospitals set prices and why they differ so widely.
The average price charged to Medicare for a lower joint replacement ranged from $72,393 at Greenwich Hospital to $23,063 at Charlotte Hungerford in Torrington.
"Consumers deserve to have as much information about the quality and price of their health care as they do about cars, restaurants and appliances," de Brantes said.
The state's grade "seems undeserved,'' said state Department of Public Health spokesman William Gerrish, because consumers have access to some pricing information on the website for the department's Office of Healthcare Access and through the Freedom of Information Act.
Connecticut laws require health care facilities to report total charges (gross revenue) and total payments (net revenue) to the state Office of Health Care Access. These total amounts are not specific to particular procedures.
In addition, OHCA posts the current "pricemaster" -- a detailed price list for supplies, services and pharmaceuticals -- that hospitals can include on a detailed patient bill. Consumers can ask OHCA to verify hospital charges upon request.
Many experts said price transparency is more important than ever because a growing number of consumers face greater out-of-pocket expenses with high-deductible health plans.
"These plans are placing a great financial burden on individuals and families," de Brantes said. "The cost of every health care service matters because it's coming out of consumer's pockets."
The shift to high-deductible health insurance plans is part of a national trend, according to Kevin Counihan, chief executive officer of Access Health CT, an online marketplace that will begin selling health insurance plans in October with coverage effective Jan. 1, 2014, as a result of health care reform.
The trend is "great for employers because they can fix their budgets. But most employees aren't experienced or trained to make health insurance decisions," Counihan said.