Paper R

HAP 442

Legislative Hearing

Descriptive information:

The title of the hearing that I chose is Health Care Costs. The Senate Health, Education, Labor and Pensions Committee held a hearing on health care costs. Health care executives testified on providing quality health care and costs to consumers. They also had to answer question by members regarding how to have more transparency in the health care field and industry. They also talked about how to have more openness with doctors and insurance companies and how patients can have more access to information of the costs of health care services. They wanted to find a way to do this through online resources such as websites and mobile applications. A few names of those who were in attendance include the following: senator Patty Murray, senator Lamar Alexander and senator Elizabeth Warren. This hearing occurred on September 18, 2018 (Health Care Costs).

Background information:

Health care costs have continued to rise over the years and it has caused many Americans to go into debt or to not get health care insurance at all. According to the Centers for Medicare and Medicaid Services, “national health spending is projected to grow at an average rate of 5.5 percent per year for 2017-26 and to reach $5.7 trillion by 2026” (NHE Fact Sheet). There should be a discussion on how costs can be lowered and how the public can find costs more easily. There are some health care organizations that provide cheaper or free health services so they should know how to look it up and find this information.

Having access to information about the price and quality of healthcare services can help consumers make better decisions about their care. Transparency between doctors, insurance companies and other health care providers to the public can help build good communication and patient customer service. According to Health Catalyst, “United Healthcare and other payers have a cost estimator application available online to its members. In addition, some health systems are publishing quality information on their websites” (Brown).

Summary of the testimony heard:

Senator Lamar Alexander is a republican from Tennessee and he is on the Health, Education, Labor and Pensions Committee Chair. He was the first person to speak at this hearing and began talking about senator Murray’s interest in the bill and how she is for increasing the funding for biomedical research at the National Institute of Health and how he is for it. He spoke about how it is difficult to know how much a health care service can cost before you go. He told a story that someone told him about getting a test that would have cost less at a doctor’s office than in a hospital. He stated “Consumers are so left in the dark that they often feel powerless” (Health Care Costs). He made it clear that on the internet you can compare prices for many different items but for healthcare it is not so easy and patients are not aware of the prices. He also explained that this hearing is the fourth in a series of hearings in regards to making the prices of healthcare more readily available for consumers so that they can make better decisions for their wallet and for their health. He describes the hiding of prices as the “black box” and says that people believe that higher prices equals higher quality but that is not always true (Health Care Costs),. He believes that transparency will help consumers such as employees to make better decisions and will make the economy better for them. One of the questions that he asked was to Mr. Tippets and it was in regards to the 10% of people who pay cash may have insurance and why might they pay cash instead. The answer was that some have high-deductibles and it may be cheaper for them to pay out of pocket.

The next person to speak was senator Patty Murray and she is a democrat from Washington and she is a Health, Education, Labor and Pensions Committee Ranking Member. She spoke how the alliance could help children, women and those affected by diabetes. She says that one in out of three dollars that are spent are part of unnecessary spending and states that Trump is making it harder for people to find out information about healthcare service prices. She says that the Navigator program helps those who are trying to understand our complicated health care system and for those who are trying to get health care insurance for their families. This program is also guided towards those who their first language is not English and those who do not understand medical terminology or how the health care system works. The funding for the navigator has been cut and they are not informed ahead of time so that they can make changes to make up for the million dollars of funding that is being cut. She says that this administration is “sabotaging” the American people and that Trump gave insurance companies the power to sell “junk insurance” to consumers that are discriminative against older people, women and those with pre-existing conditions (Health Care Costs). She also says that transparency is great but just that alone is not enough because if a drug company give out their prices to the public, that is good but it does not help the people who cannot afford it.

The first witness is Leah Binder who is the president and CEO of the Leap Frog Group who is working on improving the safety and quality of hospitals and she used to be the vice president at Franklin Community Network in Maine. She explains how her organization works on transparency by allowing hospital performance information to be public. They have been doing that for 18 years and have found it to be a successful method in improving care and lowering costs. They have representatives for each state so they work regionally and not just federally. They have C-section ratings by hospitals and that information cannot be found anywhere else. She says that price transparency is not enough and bad care is very common. Consumers also deserve to know which hospitals have less medical errors and provide better care. By grading hospitals, they take more initiative to be graded an “A” and take more control on how to better the safety and quality of their patients since that information is open to the public. The Leap Frog group wants to work with the administration to have more transparency but they feel that the CMS is not concerned with the people and making the patients their priority.

The second witness is Bill Kaptine who is the co-founder and senior vice president of Plan Analytics Heath Care Bluebook in Nashville, Tennessee, which is an online tool that helps consumers find high quality health care options at fair prices. He spoke about how price variability is an issue in the U.S. and that is why transparency is important. He said that over the years he has seen that if consumers use cost effective providers in their network, both consumers and employers can save a lot of money. Medical bills are the number one cause of debt, and they have found that consumers who are informed are more likely to make cost-effective decisions. Also he believes that independent solutions need to be at the center of transparency since they are free from conflict of interests with industry stakeholders. He wants better access to CMS data in regards to outpatient surgery and the ambulatory center setting so that consumers can compare the prices between these two locations. He also believes that there should be policies that encourage competition between hospitals

The third witness is Nancy Giunto who is executive director of the Washington Health Alliance who helps provide information to consumers about health care services. She has also worked at the NIH, American Hospital Association and Providence Health Services. She suggests that health literacy is important for consumers.

The fourth witness is Ty Tibbets who is the administrator the Saint George’s Surgical Center, a physician owned ambulatory center in rural Utah and in 2014 they started posting cash prices online on all surgical procedures so that the public could see it.

Senator Elizabeth Warren stated that consumer health protection act helps with transparency and helps with affordable health care and competition so that providers have to compete. Senator Lisa Murkowski, a republican from Alaska, asked how will congress mandate the education and engagement part of the policy and how do they engage people early enough to participate. Leah Binder stated, “the role of government is to ensure that the data is reliable and available and to make that available to public entities and they have an incentive to give it to the public and encourage them to learn” (Health Care Costs). Nancy Giunto answered this question by saying that congress can help inform consumers that insurance is “shoppable” and that it is good to help with the concerns locally.

Senator Tina Smith, introduced a bill that would help to lower administrative costs. The bill helps to cut costs and cut the burden on providers and it has been successful in Minnesota. Her question was in what ways could efforts to streamline and automate administrative and clinical systems help with transparency? Nancy Giunto answered that it could help patients with unnecessary costs if they know the price of a service online (Health Care Costs).

Senator Tim Scott asked what steps can take they take improve the shopping environment for consumers? Mr. Kaptine stated that they have worked with employers and they saw that the three most important factors are education (when consumers know that prices and quality vary, they are more likely to shop around and compare providers), simplicity (it has to be easy for people to shop and understand what they are looking for in their town and what is a reasonable price), and value based incentives (this encourages people to shop for care).

There were also questions about how people with certain conditions could compare different hospitals or providers to know which is best for their condition. Leah says that CMS needs to have more information about hospitals other than just how average they are. Ms. Giunto said that high costs do not equal better outcomes and she found that information by comparing different entities.

Stakeholders who will be affected by the policy, and the impact of the policy on:

With transparency, consumers can look up information about prices for health care services so that they can make better decisions for their care not only quality wise but money wise. Providers will have to provide information about the costs of their services so that the public can know of them. Stakeholders will be affected because their organization’s information would be public with consumers and that could have some backlash and have negative outcomes for their hospital. Also this could create more of an incentive for providers and stakeholders to better their quality. For employers, they will have more education on how to choose insurance programs that are affordable and beneficial to their employees. For payers, this could cause some issues since many programs charge a lot more than others and this element of surprise can confuse consumers and make them believe that the more expensive choice is the right one. It would also cause the payers of insurance to have more motivation to inform consumers of making good decisions financially. The people who want to keep prices a secret are the ones who will not like this policy but it will help the public make more affordable and educated decisions about their healthcare.

Your observations and analysis:

I believe that there was a balance of perspectives presented because there were democrats and republicans asking questions which showed that both sides are interested in transparency. Also there was a diverse group of people that testified and that showed that everyone either administrators or CEOs of an organization can come together to come up with ideas to help consumers. The testimony that seemed most effective was Leah Binder’s because she provided a lot of good answers to questions and good recommendations. She told the truth about what is wrong with the CMS website and what they can do to make transparency better. Her organization, the Leapfrog Group, does a lot of good to make sure that hospitals are graded on their quality and patient safety. Inova Mount Vernon was given a grade “A” by the Leap Frog Group and so that hospital is one that I trust. I think they could have had a perspective from an insurance representative to see how they feel about this policy or a stakeholder in a hospital. This experience changed my understanding of political and legislative processes by making me realize that a lot of discussion needs to happen before a policy is enacted, that there are many steps to take and that it is important to see how different parties and entities feel about the policy to make sure that it is doing more good than harm. This hearing was really important in regards to the issue about transparency because the amount of money being spent on healthcare is rising every year and the American people need more options on how to find affordable health services and how to purchase cost-effective healthcare. Many consumers have high deductibles and cannot afford to get the care they need even if they have insurance and the number of people with chronic conditions is increasing. There needed to be a discussion on how consumers could make better financial choices and transparency is a step in the right direction.

Reference

Brown, B., Skelley, L. The Key to Overcoming the Challenges of Transparency in Healthcare. Retrieved from https://www.healthcatalyst.com/Key-Overcoming-Challenges-Transparency-in-Healthcare.

Health Care Costs. (2018). Retrieved from https://www.c-span.org/video/?451615-1/senate-hearing-focuses-health-care-costs

NHE Fact Sheet. (2018) Retrieved from https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html.