Previewing the Alliance’s Latest Work

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Previewing the Alliance’s Latest Work

Hospital costs is a big topic these days. It’s not surprising when one-third of our health care dollars go to care in hospitals. And on the consumer side, medical bills are getting national attention. Just look at NPR and Kaiser Health News’ Bill of the Month series, Vox’s reporting on ER bills, and hospital collection efforts that are making national news. A recent Kaiser Family Foundation poll shows that nearly 80% of Americans support legislation to protect people from surprise medical bills.

Here in Washington, the new year rings in the implementation of our Balance Billing Protection Act, considered to be the nation’s strongest to prevent surprise medical billing and balance billing.

The law requires:

  • notice to be given to patients about their rights regarding medical bills;
  • insurers, providers, and facilities to maintain current network information online;
  • a consumer who has a procedure at an in-network hospital to not be balance billed;
  • patients obtaining emergency care at an out-of-network hospital in a state that borders Washington to not be balance billed;
  • an out-of-network provider or facility to be paid directly by the insurer and if they do not agree on the amount within 30 days, the dispute goes to binding arbitration; and
  • the Washington state Department of Health to enforce the law against providers who continue to balance bill patients.

Consumers who are enrolled in a self-funded health plan can also be protected under the law, so long as the self-funded purchaser submits notice to the Office of the Insurance Commissioner (OIC) 30 days before its intention to participate. At our next Purchaser Affinity Group meeting on December 19th at the Alliance office, Senior Health Policy Advisor at the Office of the Insurance Commissioner Jane Beyer will be discussing how the new law will affect self-funded purchasers and what exposure they may face by electing to participate. More information from the OIC about the Balance Billing Protection Act is available here.

National change is also on the way. Last month, CMS unveiled its final rule to take effect on January 1, 2021, for hospitals to make public a list of standard charges for their items and services. At more than 300 pages, it’s a lot to take in, but one thing is certain, hospital costs are coming under great scrutiny. You may have seen my recent quote in a Seattle Times editorial, Hospital-Cost Transparency Is a Necessary First Step to Affordable Health Care, “Transparency is foundational to helping improve the market. That said, it’s tricky to talk about price in a way that’s approachable for people.”

We understand that it is challenging to report on pricing. It starts with trusted relationships with those who supply the data and a deep knowledge of how billing works in our state. It takes a multi-disciplinary group of stakeholders to parse through the details to help us make sense of the information and display it in a way that is fair and unbiased from all perspectives. In a report issued earlier this year, we found great variance in inpatient treatment prices (including facility and physician’s fees). We found not only a wide range across the state but within individual hospitals as well. Not only are prices vastly different between hospitals within the same system, there is also great variability in prices paid by health plans to the same institution based on the covered population.

And as we all know, cost is only one part of the equation, quality and patient experience are essential as well. That’s why our latest analysis due out shortly on hospital value, where we look at quality, patient experience, and allowed charges will be released to the public. Our first two Hospital Value Reports were distributed to members only, but we believe it’s time that this information be available to all of us working on improving the health care system. Here is a sneak preview of the key message of the report – you don’t have to pay more for quality inpatient hospital care. Some of the highest quality hospitals in our state are among the most efficient. That’s a message that the public, policymakers, employers, providers, and health plan decision makers should all hear.

Committing to transparency is hard work. It takes courage and the willingness to reveal information that is sometimes unpopular and challenging to address. But none of this happens without your support and tough critiques along the way. Let’s focus our time using what we know to improve the health and health care of Washingtonians.

Wishing you a healthy and happy holiday season and brilliant new year!

All the best,

Nancy Giunto

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