OSMA Continues Work Toward Price Transparency Solutions

The Ohio State Medical Association (OSMA) continues to be an active participant in discussions regarding creating and implementing an effective system for health care price transparency in Ohio. 


In joint testimony presented on January 24 to the House Insurance Committee, the OSMA and the Ohio Hospital Association (OHA) affirmed that physicians and hospitals are supportive of price transparency for Ohio’s patients, but urged that the system for getting cost information to patients must be constructed in a way that does not place undue burden upon physicians and hospitals. Excessive administrative burden, the groups warned, could have a negative impact upon patient care. 

State Rep. Stephen Huffman (R-Tipp City) introduced HB 416 in late 2017, in an effort to give patients a clearer idea of what their doctor or hospital bill will be before a medical procedure is performed. His legislation is a direct response to the state price transparency law that was set to go into effect in January 2017.  However, the law was halted when multiple health care associations, including the OSMA and OHA, sued the state over the new statute. 

In the lawsuit, the OSMA, OHA and the other organizations argue that the law violates numerous provisions of the Ohio constitution and contains mandates that would be difficult or even impossible to comply with for many physicians, resulting in frustration and administrative entanglements that could ultimately risk patient harm. 

The OSMA and OHA have collaborated on this challenging topic for several years now and share a similar perspective on creating a solution. The overall message of the testimony last week was clear: passing a law with which it is impossible to comply would not be helpful for anyone, and providing meaningful price information to patients is possible. However, for the concept to come to fruition effectively, providers would need to be able to work collaboratively with payers. 

“Providers alone do not have all of the information necessary to provide a patient a meaningful estimate of the cost of a health care service. As you know, individuals’ health plan coverage varies dramatically, and the only way to provide them a meaningful estimate is to get information about their coverage that only the payer has,” Sean McGlone, General Counsel at the OHA stated during the testimony given alongside Tim Maglione, the OSMA’s Senior Director of Government Relations. 

The OSMA and OHA explained that continuing to saddle practitioners with more administrative demand threatens to take away time they spend on their most important task: providing quality care to their patients, and the task of chasing down out-of-pocket costs for every service performed for every patient in their practices would be a massive, time-consuming, and labor-intensive undertaking. 

The groups testified that Dr. Huffman’s efforts to craft a price transparency solution in HB 416 are appreciated by the medical community. They asked the Committee and stakeholders to give the provisions of HB 416 deserved consideration, as many health care groups believe the legislation’s language is a significant improvement over the current law, and it is a great starting point for future discussions. 

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), HB 416 would:
Require providers to provide estimates for any service scheduled seven days in advance upon the patient’s request
For any service for which the payer requires prior authorization, the payer would be required to provide an estimate to the patient. 

In the past, both organizations have indicated support for a proposal that would:
Require providers to provide estimates for any service upon the patient’s request. 
Require providers to provide estimates for certain other “shoppable services” even if a patient does not request the estimate. We are not aware of any state in the country that requires providers to provide estimates even if the patient does not request it. 

This requirement would be contingent on: 
The payer giving the provider the information necessary to provide a meaningful estimate within a certain time of the request from the provider; 
The service being scheduled at least 7 days in advance, to allow the provider and payer to work together to obtain the necessary information. 

Last week’s testimony reiterated these ideas as well, and communicated a strong belief that this framework would solidify Ohio as a national leader in health care price transparency.  
In the coming months, work will be done with the sponsor of HB 416 to achieve meaningful price transparency. The OSMA will continue to advocate for a solution that does not increase the administrative burden placed upon physician practices. 

Due its complex nature, the deliberations about this issue and legislation are likely to continue for some time. Meanwhile, the lawsuit over the current state law is still pending. The OSMA will give feedback on behalf of Ohio physicians as the conversation surrounding HB 416 and price transparency evolves. 

Stay tuned for updates from the OSMA on any new developments.