By Jane Norman, CQ HealthBeat Associate Editor
April 25, 2013 -- Both Republicans and Democrats at a House hearing last week expressed interest in ways to seek more transparency in the pricing of health care, with the idea that health care costs could be reduced if patients had more information about the cost and quality of their medical services.
There were some partisan jabs during the Oversight and Government Reform subcommittee hearing, and widely varying opinions of what the health care law (PL 111-148, PL 111-152) might or might not do to reduce costs—both for the system and for individuals. But there also appeared to be a bipartisan desire to find a way to repair a U.S. health care system that the Institute of Medicine in a 2012 report said wastes 30 cents of every health care dollar.
Republican James Lankford of Oklahoma, chairman of the Subcommittee on Energy policy, Health care and Entitlements, criticized a "massive bureaucracy focused on claims processing" that creates frustration among both providers and patients. And he distributed a letter sent to him by G. Keith Smith of the Surgery Center of Oklahoma, a physician-owned facility that displays its surgical prices online and wants to start a "price war" that will lower the cost of care.
Jackie Speier of California, top Democrat on the panel, cautioned that she doesn't believe in forcing patients to have more "skin in the game" as a cost-cutting approach because too many people already report going in to bankruptcy due to medical bills. But she also said it's a problem that consumers can't shop around for a deal, and that medicine is different than any other market in that way.
Something is "fundamentally wrong" when U.S. consumers pay so much for health care and get back so little value, she said.
Limited Access to Data
Martin A. Makary, a surgeon at Johns Hopkins Hospital in Baltimore who's written a book titled "Unaccountable" that advocates for more transparency, told the panel that one major problem is the lack of public access to publicly funded data bases that could provide more information on patient outcomes.
For example, a national pancreas transplant registry funded by the National Institutes of Health tracks patient outcomes through voluntary reports, he said. But the data is not disclosed to the public, Makary said.
A research team he worked with was able to finally access data to try and determine whether minimally invasive laparoscopic surgery was being frequently used in situations where it is established that it leads to lower infections, less pain and better functional outcomes compared to open surgery, Makary said. They found that the use of less invasive procedure varies widely for common procedures like appendectomies, with differences depending on region and the training of providers.
But he said more disclosure of the information in the registries is needed so similar comparisons could be made.
"There are over 150 national clinical registries which track patient outcomes. One quarter are taxpayer funded, yet only three make their outcomes available to the public," he said. "Making public access a condition of taxpayer funding is one simple reform which would allow the free market to work to cut waste in health care."
John Goodman, president and CEO of the right-leaning National Center for Policy Analysis, praised "doc in the box" clinics that post prices for routine and preventive care. "In health care few people ever see a real price for anything," he said.
Another witness, Lynn Quincy, a senior policy analyst with Consumers Union, said that "improved transparency is an issue we can all get behind." But she cautioned that too much transparency can lead to confusion, using as an example the long and wordy privacy notices required to be issued by doctors and other health care providers.
For health care, the best information would include the final price paid by the consumers; allow consumers to compare by price alternative treatments, drugs or providers; and provide some kind of indication of the value of the treatment, she said.
Democrat Elijah E. Cummings of Maryland agreed that too much data is overwhelming. "We have people in Congress who don't know how to read data, with law degrees," he said. "I want to be practical."