Massachusetts leading the way again on healthcare reform

Rss@dailykos.com (joan Mccarter)
Saturday, October 11, 2014, 7:13 pm
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A new law in Massachusetts mandates transparency in healthcare services pricing, allowing anyone in the state with private health insurance to go to their insurer's website and find out how much a given procedure-office visit or MRI-is going to cost. That's actually pretty huge, as WBUR's Martha Bebinger reports in conjunction with Kaiser Health News.
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It's a seismic event. Ten years ago, I filed Freedom of Information Act requests to get cost information in Massachusetts - nothing. Occasionally over the years, I'd receive manila envelopes with no return address, or secure .zip files with pricing spreadsheets from one hospital or another.
Then two years ago, Massachusetts passed a law that pushed health insurers and hospitals to start making this once-vigorously guarded information more public. Now as of Oct. 1, Massachusetts is the first state to require that insurers offer real-time prices by provider in consumer-friendly formats.
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"This is a very big deal," said Undersecretary for Consumer Affairs and Business Regulation Barbara Anthony. "Let the light shine in on health care prices."

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Amen. Healthcare pricing is notoriously varied and indiscriminate. A procedure that costs several hundred dollars at one hospital can cost in the thousands at a hospital in the next town, and essentially no insurer pays the same for a given procedure as another insurer. It's part of the multi-layered dysfunction in our system that has helped to drive costs so high. This is a great start toward some transparency, that can hopefully, eventually lead to some rationality in pricing. That's with a bunch of caveats, though, that Bebinger details.
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First, looking at the price of a test or procedure at one site won't tell you necessarily what it should cost-this is where variance comes in. Bebinger checked out bone density scans: $16 in Tufts Health plan; $87 in Harvard-Pilgrim Health Care's system; $190 for Blue Cross Blue Shield of Massachusetts. Some of the prices reflect all of the charges included in the test-for example anesthesia included with some invasive tests-but others aren't inclusive. The law doesn't have a definition of "price" and what all that should include, so what you see on the insurer's website might not be what you get. Additionally, Bebinger found that prices tend to change, and change frequently. Within five days, the price for the bone density scan she researched increased from $120 to $190 at Blue Cross.

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