In a move to improve healthcare price transparency, Colorado hospitals must now post self-pay prices for the most common procedures and treatments, Denver Business Journal reported.
The new law that took effect on Jan. 1 requires hospitals provide pricing information for the 50 most used diagnosis-related group codes and 25 most-used procedural technology billing codes.
Physician offices and providers must also provide prices for their 15 most common procedures.
The pricing information is only for uninsured patients, which makes up less than 7% of the Colorado population. What a hospital bills an uninsured patient is different than what it would charge an insured individual. So, the new law is a step in the direction of more transparency, but it’s limited to patients who would need to pay the full bill without any help from insurance. The law doesn't include what an insured person would need to pay out-of-pocket.
The new law is part of an ongoing movement to offer better pricing transparency. Providing that information allows patients to compare prices among facilities and lessen a surprise when the hospital bill arrives later.
Healthcare cost data can be hard to find and if the information is available, the vast majority of patients don’t look for it before receiving care. A recent Health Affairs study found only 13% of respondents said they researched out-of-pocket costs before getting care. Only 3% of those surveyed said they compared healthcare costs by provider before receiving care. In addition, just one-quarter of them used a health plan, employer or public website.
Payers have been exploring new ways to get their members to use healthcare cost and quality data. One example is Blue Cross Blue Shield of Massachusetts, which recently launched the SmartShopper Program for its self-funded employer plans. The program will reward members $250 per procedure when they “shop for and get care from lower cost, quality providers for eligible procedures like MRIs, mammograms and colonoscopies.”
Healthcare consumerism and providing cost and quality data are seen as key planks of high-deductible health plans (HDHPs) and creating more educated healthcare consumers. The movement is expected to only increase in 2018. Michael Abrams, co-founder and managing partner at Numerof & Associates, recently told Healthcare Dive, “In the new market-based healthcare landscape that is evolving, buyers will look for transparency, accountability for cost and quality across the continuum and consumer choice based on real competition."