“The insurance industry still has a dramatic advantage over particularly smaller physician groups and smaller health care organizations. There's not a level playing field there,” Ehrenberger explains.
That's because big insurance companies pay bills at hospitals all over the state, so they have a big picture view of how much everybody charges for procedures and details such as complication rates. Individual hospitals only know their own prices. It’s as if only customers could get a list of prices for different coffee makers, but Cusinart and Mr. Coffee can't, so they don't know if they're asking too much or too little for their coffee makers. The better picture Ehrenberger can get of the marketplace for health care services, the better he can set prices.
“What we want to do is be able to have the data that shows, unequivocally, that we can provide a better quality product, and a cost they can afford,” he says.
But there’s a glitch. In order to get the kinds of reports Ehrenberger and other health care providers want, they have to include price information from all payers, and one of the biggest is Medicare -- it pays about a fifth of all health care bills in Colorado. At the moment, Edie Sonn explains, they cannot use that Medicare data in any of the custom reports they want to sell.
“Current federal law restricts what we can do with that Medicare data,” she says. “The only thing you can use their data for is public reporting.”
Sonn's organization and others like it have found support on Capitol Hill to let them sell Medicare data. It turns out that Democrats and Republicans agree that price transparency is key to controlling costs. A measure making the change is now part of a bigger Medicare bill (find it in section 107) working its way through Congress. If it passes, Colorado will be one step closer to making shopping for health care as easy as shopping for a coffee maker.
This story is part of a partnership between NPR and Kaiser Health News.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.
Sat, Feb 15 2014