Improving Washington’s grade on price transparency
No one likes a failing grade. But in the 2015 Catalyst for Payment Reform (CPR) – Health Care Incentives Improvement Institute (HCI3) Report Card on State Price Transparency Laws, Washington didn’t fare too well. In fact, we got an F. Nearly all states did, and have for the three years the report has been issued, because of ongoing challenges to enacting price transparency nationwide. The bottom line is this: 90 percent of states fail to provide adequate price information to consumers. Only five states received a grade of C or better (Colorado, Maine, New Hampshire, Vermont and Virginia), and only one received an A (New Hampshire). In the majority of the United States, to get information about the price of a procedure, patients must muddle through phone trees to get procedure codes to get estimates from their insurance companies, and even then, the information may not be complete.
According to the report, the most promising legislation offers the following:
- A good-faith estimate of the patient’s out-of-pocket expenses specific to the patient’s insurance plan, health care needs and health care provider.
- Quality information on individual physicians and providers.
- Access to this information in real time via a website, personal electronic device, or Electronic Medical Record (EMR) system.
Despite our failing grade, Washington was cited as an example of a state that is moving toward increased price transparency because of legislation passed in 2015. The All-Payer Claims Database and subsequent work to make price and quality information available to the public will help to make health care cost more transparent for patients in Washington and, hopefully, improve our failing grade.
But we have to keep this in mind: Transparency is only a tool to get us to high-value care. Tackling unwarranted variation—in cost, quality and patient experience—is how we will create a better overall health care system and better care for patients.