| Hello from a very snowy Washington, DC! The schools and government might be shut down, but VoxCare stays up and running even in blustery weather. Today I want to talk about something quite near and dear to my heart: health care prices! Namely, when they benefit from transparency — and when they don't. Let's dive in. —Sarah | | | | | The Trump administration rang in 2019 by enacting a seemingly great health care policy: requiring all hospitals to list the price of their most common procedures on their websites. The whole idea was to make the American health care system more transparent, allowing patients to research the cost of care at thousands of hospitals across the country. "We are just beginning on price transparency," Medicare Administrator Seema Verma said when she announced the policy last April. "We know that hospitals have this information and we're asking them to post what they have online." Her goal made a lot of sense: It is really hard for patients to research health care prices in our current system. One 2013 study found that nearly all hospitals could give you their parking prices — but barely any could provide an estimate for the cost of their health care services. The federal government has had this hospital charge data for a while now. I actually wrote about it five years ago, for the Washington Post, when it was first put together. All in all, it seemed like a common-sense and well-intentioned policy to liberalize health care data. And, on January 1, the policy rolled out into the real world. We've quickly seen some big shortcomings in this effort to increase price transparency — ones that tell us a lot about how hard it is to give patients good cost estimates in a health care system rife with secretive prices. One of the biggest shortcomings? The data that hospitals are posting can be hard to find, and difficult to parse. I looked up the prices at some of my local hospitals in DC. It usually took me about five to 10 minutes of searching around their websites to locate the price data — not great, but not terrible either. Once I did find it. ... That's where things got interesting. I found the price data at George Washington University Hospital pretty easily. But to see it, the hospital required me to check off multiple boxes, acknowledging "price estimates are subject to change" and "charges are not a reflecting of provider or patient responsibility." Essentially, I had to acknowledge that the prices here might not be the prices that I would face as a hospital patient. | | | | | After clicking through the list, I got to the prices themselves. It is a 4,920-row spreadsheet that looks mostly like this: | | | | | I couldn't tell you what a "2-D ECHO TTE COMP NO CONTRST" is, and I'm guessing that most patients couldn't either. And even if I knew what a "2-D ECHO TTE COMP NO CONTRST" was, it's not clear that knowing its price to be $2,283 would help me much either. These are the prices that George Washington Hospital charges for health care, but they are not the prices that insurers pay for health care. Those prices are negotiated in secret, and are not made available in this dataset. Some research has found that the actual prices insurers and patients pay bear little relationship to the published charges. This isn't to pick on George Washington University Hospital. This is just what the newly available charge data looks like at lots and lots of hospitals. As Robert Pear writes in today's New York Times, "the data, posted online in spreadsheets for thousands of procedures, is incomprehensible and unusable by patients — a hodgepodge of numbers and technical medical terms, displayed in formats that vary from hospital to hospital." So, how should a patient use this new wealth of charge data? I thought Martin Gaynor at Carnegie Mellon University had the best take on it in a recent interview he gave to Marketplace: | | | Adams: So what can consumers do with this information to help them make more informed choices about their health care costs? Gaynor: I would say nothing. I don't think this is useful information. Now maybe it's a step in the right direction. Maybe the government is starting here and wants to move in the direction of getting information out there that people actually can use that's relevant for them and that's usable, but that's not what this information is. I don't think it's useful and I don't think consumers should pay attention to it. | | | I would be a big, big fan of making health care price data more available. That's the whole point of the ER billing project I've been working on for the past year here at Vox. Unfortunately, I have to agree with Gaynor: This new dataset isn't really one that's going to do much to help patients. It's hard to parse, and doesn't really say much about what you or I would end up paying for our hospital visit. There are things that the Trump administration could do to make this data set a bit more consumer friendly. They might take a page from how California regulates price transparency. That state requires hospitals to provide the charges for their 25 most common procedures in a consumer-friendly format. All these documents are available on one, state-run website, which means you don't have to spend time poking around each hospital's website. Those sheets are a lot easier to read than the one above from George Washington University Hospital. Here, for example, is part of the charge sheet for one hospital I've been writing about lately: Zuckerberg San Francisco General. | | | | | What I like about this data is that its written in plain English. You can understand what medical services the different prices actually attach to. But, again, even this data runs into significant limitations. This is still just charge data — it doesn't show the prices that insurance plans negotiate for the patients that they cover. So unless you're at a hospital that doesn't negotiate prices with private insurers — which Zuckerberg does not, but the vast majority of hospitals do — then this charge data still won't tell you much about your take-home bill for medical services. Making that data available means doing a lot more than posting charge lists. It means making public the millions of prices that hospitals and insurers currently negotiate in secret. That's the data patients really need to understand how much their trip to the hospital will cost — but right now, that's the data that patients still don't have access to. | | | | | | | | | Graphic: Zac Freeland/Vox; Source: Dylan Scott/Vox | | | All of Congress's ideas to bring down drug prices, explained. There will be a lot of chatter in the next few years about Medicare-for-all and rightly so — it's a big area of debate for Democrats in Congress, and in the 2020 election. But we shouldn't sleep on another key issue: drug prices. Congress has lots of ideas about how to make prescriptions cost less, and some even have bipartisan support. I learned so much from a new Dylan Scott piece running down the options, and think it's well worth a read. Read more here. | | | | | | | With research help from Caitlin Davis Today's top news - "House Democrats launch drug pricing investigation into 12 major companies": "The House Oversight Committee on Monday announced an investigation into 12 pharmaceutical companies and their drug-pricing methods, billing it as one of the broadest inquiries in decades into how drug manufacturers set prices. It is the fulfillment of a pledge from Rep. Elijah Cummings (D-Md.), the committee chairman, who has said he will make high prescription drug costs a top priority in his oversight agenda." —Lev Facher, STAT
- "V.A. Seeks to Redirect Billions of Dollars Into Private Care": "The Department of Veterans Affairs is preparing to shift billions of dollars from government-run veterans' hospitals to private health care providers, setting the stage for the biggest transformation of the veterans' medical system in a generation." —Jennifer Steinhauer and Dave Philipps, New York Times
- "Judge blocks Trump birth control coverage rules in 13 states": "A U.S. judge in California on Sunday blocked Trump administration rules, which would allow more employers to opt out of providing women with no-cost birth control, from taking effect in 13 states and Washington, D.C." —Sudhin Thanawala, Associated Press
- "Kentucky Sen. Rand Paul is going to Canada for surgery": "Kentucky Sen. Rand Paul, one of the fiercest political critics of socialized medicine, will travel to Canada later this month to get hernia surgery. Paul, an ophthalmologist, said the operation is related to an injury in 2017 when his neighbor, Rene Boucher, attacked him while Paul was mowing his lawn. The incident left Kentucky's junior senator with six broken ribs and a bruised lung." —Thomas Novelly, Louisville Courier Journal
Analysis and longer reads - "Democratic governors steer party to left for universal health care": "Gov. Gavin Newsom wants California to be the first state to offer Medicaid to undocumented adults. Gov. Jared Polis wants Colorado to pioneer a multi-state single-payer system. And in Minnesota, Gov. Tim Walz wants residents to be able to buy into Medicaid. These radical moves by newly elected liberal governors reveal a new movement among Democrats on health care in advance of the 2020 presidential campaign to see just how far the party will go in pushing universal health care." —Dan Goldberg, Politico
- "Hospitals' solution to surprise out-of-network bills: Make physicians go in-network": "Among the myriad solutions proposed for the widespread problem of surprise medical bills, some industry insiders say simply requiring in-hospital physician groups to contract with the same insurers as the facilities they work in could go a long way. Such stipulations were commonplace decades ago, but some experts say the practice slipped out of favor around 2000 as major physician staffing companies—which tend to make more money when they're out of network—gained market power." —Tara Bannow, Modern Healthcare
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