2 Gastroenterologists on the Question of Price Transparency
Ask a Gastroenterologist is a weekly series of questions posed to GI physicians around the country on business and clinical issues affecting the field of gastroenterology. We invite all gastroenterologists to submit responses. Next week's question: What skills do young gastroenterologists need to succeed in the current healthcare environment?
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Question: Does it make sense for gastroenterologists to embrace price transparency?
Maxwell Chait, MD, FACP, FACG, FASGE, AGAF, ColumbiaDoctors Medical Group (Hartsdale, N.Y.): Price transparency frameworks, which provide price information presented in the context of other relevant information, should be developed to meet patients' needs.
The information needs to be presented in the context of other relevant information. Price transparency must provide clear, readily accessible information to patients, allowing them to make comparisons among gastroenterologists. It will necessitate the identification and development of information and tools by gastroenterologists, patients and payers.
However, these tools have yet to be fully developed. For insured patients, transparency tools should include total estimated price of service; clear indications of whether providers are in a specific plan; clear guidance of patient's estimated out-of-pocket expenses and other relevant information. Patients and payers should be provided upon request clinical outcomes and patient safety data, which should be available. This would identify high quality practices.
For uninsured and out-of-network patients, the gastroenterologist should be the main source of price information. Providers should be able to give relevant information, including an estimated price, and communicate these estimates and detail what they include. However, this is a two-way street. Payers and governmental agencies must also have transparency. They need to show what are their true allocations and costs to see where and how the premium payments are used to make their decisions to offer fair and equitable determinations to maintain high quality and efficiency. They must avoid stripping the system to the bare bone to maintain profits that would adversely affect quality, patient outcomes and safety.
Gastroenterologists, governmental agencies and payers should join in a concerted effort to provide the price information that gastroenterologists, patients and payers require to make decisions without adversely affecting quality and efficiency in patient care.
Rajeev Jain, MD, AGAF, AGA Institute Practice Management and Economics Committee Chair, Partner, Texas Digestive Disease Consultants (Dallas): In a truly competitive market, the buyer understands the goods or services being traded, prices are transparent and competition exists. In healthcare, these market forces have been limited to a large extent by the unpredictability of individual healthcare needs (when and how often a person gets sick) and a complicated payment structure where both the physician and patient have little knowledge of the true costs.
When patients experience emergencies or are unable to make decisions because of altered consciousness, price transparency is not helpful. However, there are many aspects of healthcare where patients have time to shop for the best price. Examples would include elective tests, procedures like screening colonoscopy and elective surgery.
The Affordable Care Act contains provisions for transparency and policymakers at CMS are publishing hospital charges and physician payments. In May 2014, UnitedHealthcare, Aetna and Humana announced the creation of the Health Care Cost Institute, which will offer the public free access to a payment database with reference pricing. Large employers and other health care purchasers have created the Catalyst for Payment Reform to promote payment reform and higher-value care.
With the proliferation of high deductible health plans, patients are paying a greater proportion of their healthcare dollars. Additionally, more employers are offering defined contributions rather than defined benefits, such that the patients bear more financial risk. Entrepreneurs have created cost comparison websites such as Healthcare Blue Book, HealthSparq and Castlight to meet the increasing consumer demand for pricing data for medical and surgical services.
For price transparency to be valuable to patients, utilization and risk-adjusted quality data needs to accompany pricing such that high value providers can be easily selected. The movement towards price transparency in healthcare has garnered increased traction amongst policymakers, payers and patients. For these reasons, I think we should embrace price transparency so we can be involved in shaping the discussion and related policies of price transparency, rather than being defensive and reactive to mandates from others.
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