Commission, Senate Committee Push Transparency Forward

Jan 20, 2016

A final report from Gov. Rick Scott’s Commission on Healthcare and Hospital Funding is recommending that Floridians should be able to find out ahead of time what it will actually cost before going into the hospital for non-emergency treatment.

The commission wrapped up eight months of hearings and research on hospital payments Tuesday morning with a report calling for price transparency. 

“Healthcare as an industry does not currently fit the definition of a free-market system,” it reads.

A few hours later, the Senate Health Policy Committee unanimously passed SB 1496, called “Transparency in Health Care.” The bill would create a state website that enables consumers to get a price forecast for an episode of treatment from a hospital or ambulatory surgery center.

It would give consumers the right to get a written price estimate from hospitals, surgery centers, doctors, and medical-equipment providers within seven days. It also would offer consumers state help when fighting unfair charges from medical or hospital providers.

Over-chargers who acted in bad faith could be penalized, said the bill sponsor, Sen. Ron Bradley, R-Fleming Island.

“It will create for the first time an actual marketplace,” he said. “That’s what we’re trying to do.”

Some of the details still are being worked out, but the price transparency movement has gathered steam. Both the commission and lawmakers say it’s intolerable for hospitals to keep secret the amount they are actually paid, divulging only a fictitious, much-higher amount called their “charges.” 

Hospital groups have said in the past that they are required to keep payments confidential under their contracts with insurers. But Florida Hospital Association’s  General Counsel Bill Bell said that a new website FHA released last week, called Mission to Care,  provides a great deal of the information on average prices that lawmakers want to see.

Because little information is available to patients, and because someone else is generally paying most of the bill, the laws of supply and demand don’t apply to the health industry, the Commission’s report says. It calls for “protecting patients’ rights to not have fixed prices forced on them against their will in moments of vulnerability.”

Bradley said his bill calls for the state to provide a “consumer-friendly platform” on the Internet where patients could get customized information on their likely cost of care at different hospitals in the area. They could make better choices and financial preparations if they knew what to expect, he said.  It is not clear what role insurance networks would play.

The bill also calls for consumers who feel they have been billed unfairly to get help from the state’s Insurance Consumer Advocate in the Division of Financial Services. The current advocate, Sha’Ron James, is actively pushing for protection of PPO patients against what’s called ‘surprise’ billing by doctors who don’t participate in their network.

Bradley said the governor’s proposed bill would have had the Agency for Health Care Administration build a website providing the information on what episodes of care would cost. Scott requested $5 million for it.

But he said it turned out that a private company demonstrated that it already has such a product available for an estimated price of $2.7 million. A Scott aide told the committee that would be fine.

Carol Gormley, senior policy advisor on health to Senate President Andy Gardiner, identified the company as the Health Care Cost Institute, a Washington, DC non-profit.

HCCI’s website says its mission is to “provide complete, accurate, unbiased information about health care utilization and costs.”

Several months ago, Scott first accused hospitals of “price-gouging,” creating some bruised feelings among those the hospital industry and among some lawmakers. 

Bradley asked committee members to embrace the concept of increasing transparency, regardless of whose idea it was.

“I think it’s good public policy,” he said.

Sen. Aaron Bean, chairman of the committee, agreed. “This also has the potential to be a game-changer.”

The Senate Bill has a companion, HB 1175, filed by Rep. Chris Sprowls, R-Palm Harbor. It is scheduled for a hearing on Wednesday by the Select Committee on Affordable Healthcare Access.

Carol Gentry is a special correspondent with WUSF in Tampa. WUSF is part of Health News Florida, which receives support from the Corporation for Public Broadcasting.