Putting numbers on Provider Price Increases

I thought this story out of Boston was pretty striking:  A state house leader putting a number on what the average provider price increase should be.  It is impossible to imagine an Oregon politician (much less one in a leadership position) making such a statement today.  Heck, I can't even see a mainstream reform advocate saying that out loud.  And yeah, prices matter.
 
It shows that while Oregon in some ways is ahead of the game in promoting health care reform it still has a long, long way to go.

Huh (All Payer Claims Database Edition)

The MA commission reviewing provider pricing regulation came out with recommendations a few weeks ago.  The headline is that this is another step towards pricing regulation, but something else caught my eye.  One of their recommendations was to increase price transparency, and included this (emphasis mine),

Access to the All-Payer Claims Database. DHCFP is currently in the process of developing an All-Payer Claims Database (APCD), pursuant to M.G.L. c. 118G §6.  The Special Commission recommends that the state make the APCD accessible to consumers, purchasers, providers, insurers, and researchers both for standardized queries and in support of research to analyze price variation consistent with the provisions of the Data Release regulations, 114.5 CMR 22.00 et seq. Such disclosure should carefully guard protected health information (PHI), consistent with the Health Insurance Portability and Accountability Act (HIPAA). In addition, the Special Commission recommends including third-party administrators that process claims for self-insuring employers among the entities required to submit claims data to the APCD, consistent with the filing requirements for insurers serving fully-insured employers and individuals, to the extent it is legally feasible to do so.

Back in February I emailed the Office for Oregon Health Policy and Research to see if citizens would have any access to Oregon's all payer data.  The answer was no, due to privacy restrictions.  Maybe I'll forward them a copy of the MA report...

Provider Pricing Regulation takes another step closer to reality

in Massachusetts.  The fate of this proposal deserves as much attention as Vermont’s single payer plan.  Both depend on much greater scrutiny and regulation of health care pricing.

Mass AG: Time to regulate Provider Pricing

I think provider pricing regulation is both inevitable and necessary to controlling growth in health care costs.  Step by step, Massachusetts is reaching the same conclusion.  Per Incidental Economist, here is state Attorney General putting the idea out in the annual cost analysis (emphasis mine):

The competitive benefits of tiered or limited network products, however, are unlikely to counteract, on their own, the historic price disparities that threaten many health care providers. During this time of market transition, we recommend temporary statutory restrictions on how much prices may vary for comparable services. Statutory restrictions should only be used as a stop-gap to the extent necessary to moderate price distortions until the corrective effects of tiered and limited network products can improve market function. We are not recommending a return to rate setting for hospitals and physician groups. Instead, we recommend a competitive market-based approach balanced with limited government intervention to foster effective market function.

The AG can call it what she likes, she’s not fooling anyone.  Whether it’s single payer like Vermont or mandate based private insurance like Mass, all roads lead to regulating provider pricing.  All roads, that is, that work.

Followup on Massachusetts

Via Incidental Economist.  The difference in substance between the discussions there and here in Oregon is striking. 

Worth chewing on:  Annual public hearings on health care costs, as opposed to holding hearings on individual insurer filings in isolation.  Compare and contrast…

Cost Control Efforts in MA

Oregon efforts at health care reform are consumed with regulating insurance in isolation from providers, but eventually people will figure out that the only way to get cheaper health insurance is to get cheaper health care.  Massachusetts, which is a good proxy for life under PPACA is addressing the issue head-on:

The governor recently proposed legislation that would allow the insurance commissioner to scrutinize contracts setting the amounts insurers pay hospitals and doctors and reject health insurance premium increases based on excessive fees for providers.

The administration has scheduled four days of hearings starting June 27 on how to control health care costs. Legislators held their own hearing this month and are grappling with whether to support the governor’s bill, a process they have warned could take months.

Developing an effective doctrine for how, what and why providers should be compensated is the central dilemma of health care reform.  I wish MA good luck.