Most states fail on health price transparency, but not Maine

Health care prices remain hidden from patients in all but five states, preventing consumers from fully understanding their medical expenses, according to a new national report card.

Maine, however, earned a B grade. Only Massachusetts earned the same distinction, while Colorado, Vermont, and Virginia were awarded Cs. No state got an A. The rest of the country flunked.

The report was produced by the nonprofit Catalyst for Payment Reform, which works with large employers to improve transparency in health care pricing, and Health Care Incentives Improvement Institute, a Connecticut consulting nonprofit.

Last year, states fared slightly better, with 29 earning a failing grade. Maine was one of few states, among those that didn’t fail, to maintain its grade from 2013. But the grading was tougher this year. Before, states got points just for having transparency laws, but the new report judged how well those laws were actually implemented.

New Hampshire’s grade took a dive as a result. It earned an A in 2013, partly because of its law requiring prices to be publicly posted online, to an F this year, since the resulting website doesn’t work.

Maine passed a similar law, and its website is functional. Known as an “all payer claims database,” the site pools together health insurance claims to paint a picture of pricing for hospitals, doctors, and other health care providers. The database, operated by the Maine Health Data Organization, was launched in 2003, well ahead of the health pricing transparency curve.

The site’s chock full of information, also including hospital balance sheets and quality data, but it’s bit daunting for the average patient. For a consumer-friendly presentation on pricing, visit Maine Health Cost, a related site run by MHDO.

The report card also credited Maine’s more recent efforts. A law that took effect Jan. 1 requires practitioners to compile a list of their most common procedures — anything performed more than 50 times per year — and the price that would be paid by an uninsured patient. Practitioners must inform patients about the availability of the list and provide copies upon request.

For patients, knowing how much procedures cost can prove useful. That’s particularly true for non-emergency situations, in which patients have time to research and compare providers ahead of time, such as with medical imaging or joint replacements. Prices for the same procedure or treatment can differ from one hospital or provider to the next, often reflecting little about the quality.

A May 2013 data dump by the federal government showed Maine hospitals charge widely varying amounts for the same procedures, in some cases three times more than their counterparts.

 

 

 

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Jackie Farwell

About Jackie Farwell

I'm the health editor for the Bangor Daily News, a Bangor native, a UMaine grad, and a weekend crossword warrior. I never get sick of writing about Maine people, geeking out over health care data, and finding new ways to help you stay well. I live in Gorham with my husband Nick and our hound dog Riley.