With Law Stalled, Price Transparency Bill is Introduced at Statehouse

On Tuesday, State Rep. Stephen Huffman (Tipp City-R) introduced legislation that he says will give patients a clearer idea of what their doctor or hospital bill will be before a medical procedure is performed. His proposal is a direct response to a state price transparency law that was set to go into effect in January 2017; however, multiple healthcare associations, including the Ohio State Medical Association (OSMA), sued the state claiming the new statute has unworkable provisions that could frustrate and harm patients.

“My legislation would address those concerns while still providing price transparency for patients,” Huffman said during a press conference at the Statehouse where he introduced his legislation. Huffman, a physician, said he believes the litigation could last another two years. 

“What was passed was generally a ‘we need to do something and we’ll write the rules later," he said. “There’s been no leadership. While we’re still waiting for others to assist and write the rules (for the law) and give us direction, I decided to step up.”

The law currently in litigation would require physicians and hospitals to tell patients in advance how much their medical services will cost and how much they will have to pay versus what their insurance will cover.  But healthcare organizations have argued it is impossible in many cases for a physician or hospital to provide that level of detail because insurance coverages vary so significantly from patient to patient. This information is also not always readily available to the provider. Therefore, the current law’s mandates are unrealistic to ask of providers and doing so would negatively impact the delivery of efficient health care. 

The Ohio Hospital Association (OHA), OSMA and other healthcare associations sued the state in December 2016 to block the law from being implemented. On Wednesday, a judge announced a hearing on the lawsuit would be postponed until March 2018, just the latest in a series of delays in the case. The OHA and OSMA, in the meantime, have worked behind the scenes to try to negotiate, to no avail, the concerns within the law.

The OSMA appreciates Dr. Huffman’s efforts and believes his language is a significant improvement over the current law that was passed without any physician input. Under Huffman’s proposal, when asked by a patient, providers would be required to disclose certain specific information regarding how much their medical services will cost. Unlike the current law, which requires doctors and hospitals to proactively provide detailed information for every service, regardless of whether the patient asks for it or not, this is limited to services that are scheduled at least seven days in advance. 

In addition, if a physician must obtain prior authorization to provide a medical service, the bill would then require the insurer to provide the patient information regarding what the insurer will pay and what is the patient’s responsibility. The physician would only be required to submit the prior authorization request. The insurer would be required to provide any information regarding price to the patient. Previous language would have placed that burden upon the physician and hospital.

The OSMA prefers Huffman’s legislation over provisions in the state law and believes that it is a good starting point for future discussions. In the coming months, the OSMA hopes to work with the sponsor and interested parties to ensure meaningful price transparency for patient benefit without increasing the administrative burden on physician practices. This bill is not expected to be pushed through the legislature quickly and the lawsuit over the state law is still pending. The OSMA will continue to follow developments and alert members.