Health cost transparency proposal deserves debate

Republican state lawmakers have put forth a proposal to make health care providers give consumers access to out-of-pocket cost estimates for common procedures.

They’re shopping the proposal around and looking for co-signers and — perhaps surprisingly given the partisan divide in Madison — they may get some Democrat legislators to add their names to the proposed legislation.

State Sen. Mary Felzkowski, R-Irma, is the chief author of the bill, and said, “Health care is the only thing Wisconsinites purchase that we don’t know the price of beforehand. That has to change.”

Under a draft of her proposal, each hospital in the state would be required to make publicly available a digital file containing a list of standard charges for certain items and services provided by that hospital. They would also be required to provide a “consumer-friendly list of standard charges” for services that can be scheduled by a health care provider in advance.

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That would allow consumers to shop around when scheduling non-urgent care that patients commonly receive and can schedule in advance — things like blood tests, CT scans and mammograms.

And it would have teeth. Felzkowski’s proposal would give the state Department of Health Services the power to check for hospitals violating the bill and request a correction plan. It would also give DHS the ability to impose escalating penalties for non-compliance — from $600 a day for smaller hospitals to as much as $10,000 a day for hospitals with more than 550 beds are out of compliance.

A leading Wisconsin hospital association contends the proposed bill in many ways duplicates federal rules passed two years ago and will only result in confusion for health care providers.

Eric Borgerding, president and CEO of the Wisconsin Hospital Association, said the bill is unnecessary and that the vast majority of Wisconsin hospitals are already mostly or fully compliant with the federal transparency rules.

“Bottom line, our hospitals are ahead of the curve and new, publicly available price and quality transparency tools are emerging every day making this legislation unneeded in a leader state like Wisconsin.”

Borgerding cites rankings by Turquoise Health, a price-transparency platform, that showed nearly two-thirds of 130 Wisconsin hospitals had completed all the requirements of the federal rule.

That’s disputed by supporters of the legislation, who point to a January article in the Journal of General Internal Medicine that said nationwide most hospitals, as many as six in 10, do not comply with every requirement of the federal rules. They say federal agencies have been slow to enforce compliance.

And, in the background, we’re aware of reports by the RAND Corporation that found employers and private insurers paid Wisconsin hospitals more than three times what Medicare would have paid for the same services, the fourth highest rate of any state in the country, according to a recent Milwaukee Journal-Sentinel report.

Health care costs are a concern to us all — from individual consumers to employers faced with rising costs for its employee health plans. We don’t favor punitive measures for our hospitals and health care providers, nor do we favor redundant state and federal enforcement. But we do favor transparency in health care pricing so consumers can make the best decisions on their care and weigh it against the costs.

There are differing opinions in this debate, but it’s one that the state Legislature should hear out and then make a decision.