THE LONE STAR STATE SEEKS TO ILLUMINATE HEALTH PRICING
Volume 28, Issue 503 November 12, 2007
Christina Kent
Add Texas to the growing list of states that have passed laws to increase transparency in their health-care systems. Effective Sept. 1, 2007, a new Texas law (SB 1731) focuses almost wholly on prices and billing, in an effort to enable consumers to understand what treatments are covered, what they will be responsible for paying and why.
“Having witnessed the recent years’ incredible growth in the cost of health care, it’s become clear we need more transparency for Texans considering their medical needs,” said Senator Robert Duncan, who authored the legislation in the Senate. “This new law will move the Texas health-care industry toward becoming a more market-driven entity, which will ultimately benefit consumers and practitioners.”
To date, more than 30 states have enacted laws aimed at giving consumers more access to price and/or quality data. Texas’ law is one of the most comprehensive cost-focused measures enacted so far.
The new law standardizes billing requirements for physicians, hospitals, ambulatory surgical centers and birthing centers. These providers must:
- give patients who request it an estimate of the cost of services, as well as an itemized statement;
- inform patients whether late payments will incur interest and, if so, the interest rate;
- refund to patients any overpayment within 30 days, once the overpayment becomes apparent; and
- develop and implement discounts for uninsured and indigent patients.
The law also seeks to provide more clarity on insurance policies. HMOs and PPOs must report data to the Texas Department of Insurance for public posting, including patient satisfaction and quality of care results; coverage areas; copayments and deductibles; the credentials, names and numbers of network physicians; and a list of network hospitals, said Patricia Kolodzey, associate director for legislative affairs for the Texas Medical Association, during a webcast held by NCSL (see below).
In an effort to address what is reportedly a common complaint from patients, the legislation requires payers to tell enrollees in writing that some facility-based specialists (such as radiologists and anesthesiologists) are not necessarily in the patient’s network. The insurers must tell the patient that these doctors may bill the patient for any portion of his or her fees not covered by the insurer.
In the state sector, the bill requires the Texas Department of Insurance to study network adequacy and the costs of services in regions around the state. The Department of State Health Services must expand its Web site to include outpatient data from hospitals, ambulatory surgical centers, birthing centers and free-standing imaging centers.
States and the federal government want to move beyond claims as the only way to measure cost and quality, but the players are “stuck with administrative claims data at the moment,” Dr. Nancy Wilson, of the Agency for Healthcare Research and Quality, said during the NCSL Webcast. “Ultimately, consumers need to be able to decide which treatment to get.” But as the health-care systems moves toward value- and evidence-based information, it will begin to control the biggest driver of health-care costs: increased use of new technologies. Consumers and others will be able to determine the cost efficiency of services, deciding which ones have the most value.
To see this webcast on transparency and other archived health-care webcasts, please go to: http://www.ncsl.org/programs/health/webcast2.htm
For a listing of legislation proposed or passed from 2005 to 2007, please go to this NCSL Web page: http://www.ncsl.org/programs/health/Transparency.htm
© Copyright 2007, State Health Notes
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