Newtown, CT – December 6, 2013
Is it reasonable to ask physicians to know the price of health care services? That was one of the topics debated this week during the Price Transparency Summit in DC, and, as for many issues in health care, the answer depends. If a patient is locked in a capitated system, then the answer is no. Why would it matter to the patient or the physician since neither is actually "shopping" for health care services? But let's now focus on the 90% of consumer-patients who aren't locked into a capitated system. A good 35% of them are in high deductible and high co-insurance plans. That number will rise to close to 50% in less than a month, making the importance of prices for health care services quite evident. While health plans can and should provide consumers with easy apps that give them comparative prices on everything, from individual services to bundles, we know full well the archaic and silly reasons why they often can't. An ABC news story earlier this week highlighted the continued prevalence of gag clauses and other mechanisms used by both payers and providers to keep patients in the dark about the price of health care. The upshot was eloquently captured in a recent NEJM perspective on the price of a routine PAP smear, and indicates how much a threat to financial health health care has become.
What this means to you – whether we agree or not, consumer-patients have become just that and, for the most part, they lack the information needed to make decisions that would be in their best self-interest. Our joint work with CPR on price transparency showed that very few states had available information for consumers. Our next report card, to be published Tuesday, shows an even worse availability of quality of care information. While health plans and other vendors have tried to fill those gaps, in many instances they lack the sample sizes to provide reliable results. Public policy makers have a significant role to play, but Representative Burgess reminded us on Tuesday that we shouldn't expect that role from federal legislators. As such, the burden falls on states, and those within states who want to see change happen. In the interim, and everywhere states will lack the political courage to provide consumer-patients with quality and price information, it's up to the physicians to fill that role. A doctor should know how much a lab test costs in their neighborhood. They should know how much a routine diagnostic imaging test costs. Specialists should know the price of the procedures they routinely perform, and the difference in prices when the procedures are conducted in one facility or another. The bottom line is simple. The financial well-being of patients now lies in the hands of their clinicians. So yes, it is reasonable to ask them to know the prices for various services in their local market.
Francois de Brantes