Maine needs transparency so residents can shop for lowest-cost, highest-quality health care

By Geoff Gratwick, Special to the BDN
Posted April 17, 2014, at 3:11 p.m.

As a nation of seasoned shoppers, we have honed our skills at yard sales, in bargain basements and over the backyard fence. It makes common sense that we should also be informed shoppers for our health care.

Why shouldn’t we be able to find out the prices beforehand of nonemergency, elective medical procedures? Should we not know that a chest X-ray costs $87 at Rumford Hospital and $310 at Miles Memorial Hospital in Damariscotta? Or that a routine colonoscopy costs $971 at Cary Medical Center in Caribou but $3,167 at Mount Desert Island Hospital?

The Legislature has recently passed a bill that will allow patients and consumers to find out the prices of nonemergency, elective medical procedures beforehand. It is awaiting the governor’s signature. It is an important step that will allow us to decrease the cost of health care in Maine, particularly for those who have no insurance or high deductibles.

It is generally agreed that in the U.S., we can no longer afford our health care system. We spend twice as much per capita as most other first world countries. Despite this staggering investment, we rank from 17 th to 34 th on measures of quality. The health care dollars siphoned off by profit and waste are killing our businesses, competitiveness, economic development and jobs. In addition, it is quite literally killing us. The cost of medical services is so high that the 12 percent of Mainers with no or high-deductible insurance forgo preventive medical care until it is too late.

A year ago, TIME magazine devoted an entire issue to “The Bitter Pill,” an article describing our arbitrary, capricious and profit-oriented health care marketplace. It exposed the “Charge Master” to public scrutiny for the first time. This is a cost-shifting computer program that starts from the end (how much money a hospital must bring in to meet its needs) and works backwards to determine the charge for a particular service. It brings us Tylenol with a 1,000 percent markup and a complete blood count which cost $11 to perform for $157. All too often, there is no economic logic, no relationship between work done and the price charged.

Why do these charges matter? Many Americans never see their health care bills. Many are covered by government programs such as Medicare, Medicaid, the VA or public employee policies. Another significant group has work-related insurance. But for the final 12 percent — those who have high deductibles or no insurance at all — the cost of medical care can be ruinous. For them, price matters a great deal.

Bankruptcy and loss of all that they possess is only one illness away.

The bill passed by the Legislature will allow Mainers to be informed consumers and determine the cost of elective medical procedures beforehand. It requires all hospitals and outpatient facilities to prepare an individualized estimate of medical costs for an uninsured patient or those with a high deductible — to include facility, pharmacy, physician, laboratory and other fees. A price sheet and a contact phone number must be prominently posted. With this information, Maine consumers will be able to shop for the best quality at the best price. Hospitals and other providers will begin to realize that they exist in a competitive marketplace and begin to offer realistic prices.

In addition, the bill directs the Maine Health Data Organization to collaborate with other state and private entities to publicize health care costs. The Maine Health Data Organization and its website are not as well-known as it should be. The website currently lists the cost of 200 commonly performed procedures and tests at each of Maine’s 38 hospitals – as well as quality. This still represents only a small fraction of the medical procedures performed in Maine, but it is a good start. The site deserves a visit by all patients searching for high-quality, affordable health care.

Will the bill foster competition among providers and encourage patients to patronize those that offer quality at a lower price? For those fortunate enough to have good insurance, probably not. But for the 20 percent of those with no or poor insurance coverage, it will be of help.

It is a small step down the road to containing the costs of our runaway health care industry for the people of Maine.

Geoff Gratwick has been a physician in Bangor for 35 years and represents the people of Bangor and Hermon in the Maine State Senate.

 

http://bangordailynews.com/2014/04/17/opinion/contributors/maine-needs-transparency-so-residents-can-shop-for-lowest-cost-highest-quality-health-care/ printed on September 21, 2014