December 25, 2011

CT Consumers: No Easy Access To Health Care Costs

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Connecticut consumers don’t have an easy way to find out how much a surgical procedure, an x-ray or a blood test costs.

You could spend hours on the phone, calling hospitals, clinics and doctors’ offices to compare costs.  Even Hartford Hospital’s new CarePricer, which is designed to make patients’ queries about hospital costs easier, requires a phone call.

If you live in New Hampshire or Maine, though, the process is simple.  You just go online. Both states have all-payer claims databases, or APCDs.  The databases were created by the states and include information from Medicare, Medicaid and private health insurers on every claim they pay. Covering physicians, hospitals, dentists, physical therapists, pharmacies, and rehabilitation facilities, they allow a comprehensive look at health care costs.

A check of the New Hampshire database shows that if you don’t have insurance, the median charge for hernia surgery ranges from $4,402 at Elliot Hospital’s One Day Surgery Center in Manchester, to $17,166 (including a 15 percent uninsured discount) at Littleton Regional Hospital. Payments for insured patients vary just as much, though the amount paid to each hospital differs from insurer to insurer.

Connecticut—just in the talking stages about launching an APCD—lags behind other New England states in transparency. Besides Maine and New Hampshire, Vermont and Massachusetts also have them; Rhode Island has passed the enabling legislation to create one. APCDs are also up and running in Maryland, Tennessee, (with limited access) Kansas, Minnesota and Utah, and are being implemented in New York, West Virginia, Colorado, and Oregon.

While the wide swings in costs can be confusing to consumers, disclosure begins to open a window onto a pricing system that many experts believe needs reform. “What it shows, when you really dig into it, is that pricing makes no sense,’’ said Patrick Miller, a research associate professor at the University of New Hampshire who helped found and co-chairs the national APCD Council. “Do you somehow get better care at a more expensive hospital? It raises questions about the randomness of price negotiations between hospitals and insurers.”

Connecticut does collect hospital data, in the Hospital Discharge Database (HDD), but it is controlled by the non-profit affiliate of the Connecticut Hospital Association, ChimeData.  It contains only the official hospital charge, not the actual reimbursement.

In many states, HDDs “have been of tremendous value to look at overuse, underuse, and misuse’’ of resources, said Denise Love, director of the National Association of Health Data Organizations.  But that’s not the case in Connecticut.

The hospital association says the data helps hospitals to “meet regulatory reporting requirements and to support the association’s advocacy efforts.’’ The association does share its data with the state Department of Public Health and the Office of Health Care Access, but the state uses the data only to provide basic reports about health care trends and hospital practices.

State Effort For APCD

Two years ago, the state comptroller pushed to create an APCD, as part of its effort to reform the health care plans for state employees and affiliated municipalities.  Tom Woodruff, chief of the health policy division, attempted to bring payers, providers and others together. But the effort was derailed by concerns that the group might run afoul of antitrust laws.

Last January, the SustiNet Health Partnership board recommended that the legislature “establish convener authority…[to] allow collaboration among multiple payers and providers in developing and applying payment and delivery system innovations.” The comptroller’s office sought convener authority in this year’s legislative session, but was rebuffed.

APCDs elsewhere have not been hampered by the issue. “Collecting data has not been shown to create antitrust,” says Miller. “It’s not been an issue in other states.”

In the behind-the-scenes negotiations over this year’s health reform legislation, a “multi-payer data initiative” was placed in the new Office of Health Reform and Innovation, (OHRI).  Jeanette DeJesus, the governor’s special health care adviser, spearheads the initiative.

“Our overall approach is to have real transparency in the health care system, “DeJesus said. “Understanding what things cost, and what you will get, and who will deliver it, and what their experience is in doing it . . . can only make for better decisions for consumers.”

The Fund For Investigative Journalism supported this work.

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