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Maine Bill Seeks to Lift Curtain on Hospital Pricing
05/08/2013   Reported By: Patty B. Wight

Earlier this year, Time Magazine published an article by Steven Brill called "Bitter Pill." It lifted a curtain to reveal what goes into a hospital bill, and found huge markups at some hospitals that ranged from charging $7 for a single gauze pad to a 400 percent markup on cancer medication. The article generated national attention, and it's part of the motivation in Maine to make hospital billing more transparent. Patty Wight has more.

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The bill's sponsor, Democratic Sen. Geoffrey Gratwick, says the idea stems not only from the Time article, but also from the experiences of his constituents. One couple recently tried to price a colonoscopy at different hospitals, and described their experience to Gratwick his way:

"Quote: 'Good luck whenever we hear advice about managing your medical costs by comparing prices,'" he said. "The system is opaque, unfriendly to users, and definitely not transparent."

At a public hearing in front of the Insurance and Financial Services Committee, Jessica Falconer says she got sticker shock after treatment. When she was pregnant, she says doctors encouraged her to have a non-emergency c-section, scheduled ahead of time. The bill was $30,000.

Falconer says her insurance company will cover most of it, but she still owes thousands of dollars and never got an explanation for why it cost so much. "Frankly, my research indicates I did not require a C-section," she said. "I have to wonder where this money is going and why they pushed me this way. It makes me feel like I had a birth based on commission."

Sen. Gratwick thinks there should be no surprises for Mainers when it comes to their hosptial bills. He wants to establish a commission to review hospital financial data and make recommendations for streamlining. He also wants to use an existing independent state agency - something called the MHDO, or Maine Health Data Organization, to annually publish easy-to-understand hospital financial data on its Web site.

The MHDO actually already publishes pricing information for the most common medical treatments. To illustrate just how much information is available, the Maine Hospital Association's Jeff Austin held up mulitple packets of public data at the hearing, some that were inches thick.

"We're not against it, but we are frustrated that we are spending resources, both our time in providing the data and our cash, to help build Web sites that have exactly what you want," he said.

The only problem is that the latest data on the Web site is from 2010. Austin says the Hosptial Association doesn't oppose the bill, but that lawmakers should first make sure the MHDO has adequate resources to publish the data in a timely fashion, and do a better job marketing it to the public, so it's used.

Austin also wonders if the burden for providing data should ultimately fall on insurance companies, because it's their business to know how much things cost. Kristine Ossenfort of Anthem Blue Cross Blue Shield, who also testified neither for nor against the bill, says her insurance company already provides pricing information on its Web site.

"Our data is more current, our data is more comprehensive," she said. "And so I guess to some extent, you wonder why are they spending time and energy on information that is less precise than the information that we can provide to our members."

Everyone at the hearing agrees that hospital pricing should be transparent - the challenge is how to get there. While lawmakers consider whether Sen. Gratwick's bill is the way to go, on Wednesday the Centers for Medicaid Services released pricing data for 3,300 hospitals across the U.S.


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