Price transparency efforts so far

By Zack Budryk

The real work on price transparency is only beginning, but healthcare providers, advocacy groups and health plans are making strides, Richard L. Gundling (right), vice president of healthcare financial practices at the Healthcare Financial Management Association, told FierceHealthFinance in an exclusive interview.

"Providers have been taking most of the responsibility for the uninsured and out-of-pocket costs for high-deductible health plans [and] taking a variety of methods to help patients, from website tools to phone numbers and dedicated staff and those types of things," he said.

In March, the American Hospital Association unveiled a new price transparency toolkit that includes a checklist, case studies on member hospitals and online tools, such as the Wisconsin Hospital Association's PricePoint tool. Many price transparency efforts are at the state level. For example, in February, the Indiana Hospital Association created a database of common medical procedures and their costs, and last fall, Massachusetts took it even further, requiring health insurers to post prices for several common medical procedures.

Individual providers have had success with price transparency as well. The most complete example--and one of the most comprehensive examples in any sector--is the Oklahoma City-based Surgery Center of Oklahoma. The Surgery Center currently lists complete prices for every procedure offered, including incidental costs such as anesthesiology, with prices ranging from $15,000 to $50,000. While it only accepts cash payments from self-pay patients, it is increasingly treating out-of-state patients.

Providers are receptive to price transparency to a point, according to Jonathan Mathieu, vice president for research and compliance at the Center for Improving Value in Health Care (CIVHC), a nonprofit dedicated to advancing Triple Aim-related initiatives. The center has seen an uptick in the number of Colorado providers who support price quality transparent efforts, but he said some are reluctant to publicly release comparative quality data.

"At least in Colorado, I would say the healthcare marketplace and providers are for the most part supporting of price quality transparency efforts," he said in an exclusive interview with FierceHealthFinance. "I think when you start [introducing] comparative quality data, sometimes that enthusiasm for transparency wanes a little bit."

With that in mind, Mathieu said CIVHC works in close collaboration with providers of different types to "report price and quality data in a way that helps inform the policy debate," and does not release comparative data without giving the providers a chance to view it first.

Price transparency efforts so far