|November 1, 2012 10:50 PM

Healthcare pricing information edges closer




Would-be patients hoping to learn the cost of care before buying surgery or a CT scan are currently as blind as they would be in a supermarket with no price tags.

That was the point of a video shown at Thursday’s launch of a database that promises to help Colorado consumers learn such information.

People need information on price and quality to make sound decisions, said Phil Kalin, executive director of the Colorado Center for Improving Value in Healthcare (CIVHC).

CIVHC held the event to celebrate its progress on creating a website. The site is now open to the public, but Kalin warned the data so far posted on the site are only examples, not usable information. That’s because the site has not yet collected enough information for a complete picture.

When it comes fully online, backers of the project believe it will provide a tremendous service for Colorado consumers and policy makers. That information will include breakdowns like the total cost of healthcare per person, showing the variation by county.

It will be late next year before Colorado consumers can find price and quality information on medical care from specific providers on the site, because CIVHC plans to let the providers vet the information first.

Colorado Public News reported in May 2011 that CIVHC expected the site to be giving consumers data like the cost of having a baby at various hospitals by spring 2012. The target date is now late 2013.

CIVHC’s preliminary data – and past reporting by Colorado Public News – shows that some healthcare organizations are charging prices that are wildly higher than those charged by competitors. Colorado Public News, for example, found cash prices for a shoulder MRI in specific providers in Colorado ranged from $450 to $3,460 for the same procedure. CIVHC says it has found so far that prices for a knee MRI, including the discount prices for insurance companies, range from $297 to $1,189 [PDF].

The CIVHC project was authorized by the legislature, which had to order the healthcare industry and insurers to provide the generally secret information about medical pricing. However, the legislature did not pay for the project, which has been funded by health foundations.

Kalin said his organization was delayed because it had to fund additional funding to proceed with the full project and wait for rules to be approved by the state.

Now, before the organization reveals who is charging what price for each procedure, it plans to let providers like hospitals and clinics see where they stand on prices and quality reports for numerous procedures. The providers will have a chance to see if they are extremely high, and object to the data.

CIVHC executive director Phil Kalin said they don’t want to play “Gotcha,” but to persuade providers to improve, he said. For them, “it’s pretty frightening to think all this data is coming out.”

And there are legitimate objections, he added. For example, a procedure on a very sick patient is much more expensive than on a healthy one.

Officials promised privacy to Colorado’s patients, saying the vendor that will be collecting the health records – Treo Solutions – has an unblemished 10-year record of security. Treo even hires hackers to try to break in, Mathieu said.

Some critics, however, have objected to the project – named the All Payer Claims Database – citing the example that experience shows the privacy credit card records is breached regularly.

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1 Comment

  • To the editor:

    Thank you for your coverage of Colorado’s All Payer Claims Database (APCD). As you indicate, the APCD is an important step towards making health care prices transparent for consumers. The APCD is also designed to support businesses, providers, policy makers and other stakeholders across the state aimed at improving health, enhancing quality and lowering health care costs.

    We’d like to clarify that the information on the current website, http://www.cohealthdata.org, is indeed actual data, not simply examples. While we noted some cautions on interpreting the data during the early stages of the APCD roll-out, health policy analysts and legislators can begin utilizing the database to better understand variation in things like total cost of care by county, among other health care metrics. The database currently represents over 40% of covered lives in Colorado (Medicaid and commercially insured), and that number will grow with additional payers and data onboarding over the next year.

    As you accurately portray, consumer focused reports are expected to be available by the end of 2013. While we did originally estimate that the APCD would launch in the spring of 2012, it was never our intent for consumer reports to be part of the initial roll-out. It has always been our intent and, we think, good practice to give the providers (clinicians, hospitals, and other facilities) an opportunity to see their data, understand how it is derived and validate accuracy before being made public. We regret if there was a misunderstanding in the timing of consumer-specific reports.

    Thank you again for your coverage of this important resource for health care in Colorado.

    Respectfully,

    Phil Kalin
    President and CEO
    CIVHC|Center for Improving Value in Health Care

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