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Could laws like one in Colo. reduce medical costs? A US Senate committee aims to find out

Author: Tom Ramstack - September 19, 2018 - Updated: October 8, 2018

In this Sept. 3 file photo, an American flag flies on the U.S. Capitol in Washington. (AP Photo/J. Scott Applewhite, File)

WASHINGTON — A U.S. Senate committee held a hearing Tuesday to decide whether laws like a new one in Colorado that requires health care price transparency could bring down medical costs.

Proposals the Senate is considering would require doctors and hospitals to post their prices for common procedures on the internet.

As health insurance prices increase, patients are demanding more information about their options, said Sen. Lamar Alexander, chairman of the Senate Health, Education, Labor and Pensions Committee.

However, unlike other services whose prices and quality ratings can be found on the internet, health care remains in a “black box” of unforeseen costs, he said.

“According to the Kaiser Family Foundation, half of all single covered workers in 2017 had a deductible of at least $1,000, which is Kaiser’s threshold for a high deductible — an increase of 34 percentage points from 2012.” Alexander, R-Ky., said.

Colorado U.S. Sen. Michael Bennet, a Democrat, is a member of the Health, Education, Labor and Pensions Committee. He did not speak during the hearing Tuesday.

Colorado’s Transparency in Health Care Prices Act has required since Jan. 1 that health care providers notify self-pay patients of their prices before treatment through website postings or the like.

Hospitals must post self-pay prices for the 50 most common treatments for diagnosed illnesses and the 25 most common therapies that use “procedural” technology.

The prices can be listed as either the most frequent charge over the past year for each treatment, a range of charges from highest to lowest or the most expensive charge from among the lowest half.

Doctors in solo practice, a medical group, an independent practice association or professional corporation must post their prices for 15 of their common treatments.

The “transparency” enforced by law drew support from the Colorado Hospital Association but a caution about creating confusion from some health care organizations.

“Because of the complexity of pricing, it’s possible the self-pay prices we have posted on our website might increase confusion,” Dan Weaver, senior director of public relations for UCHealth, told Colorado Politics in January. “Patients who have insurance coverage, Medicaid or Medicare will have very different out-of-pocket responsibilities [from the posted price].”

The Colorado law applies to pricing only for uninsured patients, which represent about 7 percent of the state’s population, according to the Colorado Health Institute.

Some members of Congress want to reach beyond the uninsured to include pricing information for anyone seeking medical treatment.

A common problem for patients is that their need for medical care arises suddenly, before they have an opportunity to shop for prices, said Sen. Lisa Murkowski, R-Alaska.

“How do we engage people early?” Murkowski asked. “It seems like so much of what we’re doing is after the fact.”

An administrator for St. George Surgical Center in Utah said their “upfront” pricing for more than 220 of its procedures helps patients decide but also has been good for business.

One example mentioned by Ty Tippets, the center’s administrator, was a Montana man who telephoned to verify the price he found on the facility’s website for a knee anterior cruciate ligament reconstruction.

“After finding our price online, he called to make sure we did not have a typo in the price,” Tippets said. “The best price he found in Montana was $30,000, just for the hospital fee. Our listed price, which is fully bundled and includes doctor fees, facility fees and anesthesia is $6,335.”

However, Tippets acknowledged the price was only for patients who pay cash in advance. Different prices were common for insured patients, he said.

Tom Ramstack

Tom Ramstack