As of Jan. 1, providing cost estimates to patients who ask is no longer a recommendation but a requirement for health providers in Massachusetts. As part of Chapter 224, a major cost-containment law passed in August 2012, physician practices and hospitals have just two working days to respond to patient requests for cost information.
According to state law, the information providers must furnish includes, but is not limited to, the allowed amount or charge of the admission, procedure or service, including the amount for any "facility fees" for services performed in a hospital or hospital-owned office, stated the Massachusetts Medical Society Blog.
In December, Ronald Dunlap, M.D., president of the Massachusetts Medical Society, told the Boston Globe that he is not optimistic that physicians would be prepared to provide cost estimates to patients by the New Year's deadline.
Although few Commonwealth patients know about the law, they've actually been able to obtain cost data from health insurers since October 2013. The process of requesting information from payers, however, has been extremely tedious for patients, noted WBUR columnist Martha Bebinger in November.
To get cost-comparison data from Blue Cross for an x-ray, for example, Bebinger was expected to provide the insurer with the doctor's name and facility, the procedure codes for each x-ray that may be required, the doctor's national ID number (all information patients must call physician offices to request) and the name, address and ID number for the hospital or lab. In addition, patients are required to fill out an online form for each lab at which they want to compare prices, just one of which took Bebinger 20 minutes to complete. According to the MMS Blog, Blue Cross has so far been fielding fewer than three patient requests for cost data per day.
Expectations are that requests to physicians will trickle in as well, in part due to the amount of legwork patients have to go through to gather the information. "On paper it looks great. We've increased transparency, but in reality it's mired in red tape," Partners In Internal Medicine's George Abraham, M.D., told the MMS. "It could take days for patients to get all the information they need. It's not user-friendly."
Nonetheless, Bruce Leslie, M.D., of Newton Wellesley Orthopedic Associates, said that the law may bring a welcome marketing opportunity for community practices like his, whose costs are likely lower than at neighboring academic centers.