Hospitals worry about 'confusing picture' on health website
Friday, June 15, 2018
Posted by: DCMS
The News Service of Florida
By Christine Sexton
TALLAHASSEE --- Asserting it would help hold down health-care costs, Gov. Rick Scott’s administration created a database of paid insurance claims that allows people to shop for costs of medical procedures.
But consumers won’t be able to find price information on 71 hospitals for a variety of health care services if the state Agency for Health Care Administration sticks with a plan to make facility-specific information available to consumers before industry giant Florida Blue and other insurance carriers begin submitting paid claims data to the state.
That’s troublesome to Florida Hospital Association President Bruce Rueben, who worries that an early release of the facility-specific information on the FloridaHealthPriceFinder website will confuse, not enlighten, consumers.
The 71 hospitals are in 48 counties scattered across the state, including heavily populated Miami-Dade, Broward and Palm Beach counties, and rural counties across the Panhandle, according to the hospital association.
For example, Leon County has two hospitals --- Tallahassee Memorial HealthCare and Capital Regional Medical Center --- but without the claims data from Florida Blue and other carriers, people can’t compare prices for services at the facilities.
“This presents a confusing picture regarding the availability of services in these areas,” Rueben wrote in a letter to Agency for Health Care Administration Secretary Justin Senior this week asking that the state delay making the facility-specific data available until Florida Blue submits claims data.
Agency spokeswoman Mallory McManus refused to answer a question about when the state plans to make facility-specific information on the website available to the public. But documents obtained by The News Service of Florida show that AHCA planned to publish the facility-specific information four to six weeks after the state finalized the necessary rules, which was April 2.
Those rules give Florida Blue and other carriers until July 16 to report sample data on paid claims between 2015 and 2017 to ensure the systems are working.
The rules give companies until Sept. 14 to submit the “production” data.
Florida Blue is “currently compiling the data and working with AHCA and its contractors to securely transfer the information to them in accordance with the guidelines they provided,” Toni Woods, a spokeswoman for the insurer, said in a statement.
Scott, a former hospital-company executive who is running this year for U.S. Senate, convinced lawmakers in 2016 to authorize a statewide all-payer claims database and earmark more than $4 million to fund it.
He championed health-care cost “transparency” and the establishment of the database after hospitals in 2015 supported a proposal to expand Medicaid eligibility under the federal Affordable Care Act. Scott, a fierce critic of the federal law better known as Obamacare, opposed the Medicaid expansion proposal, which died in the Legislature.
The agency signed a contract with the Health Care Cost Institute, or HCCI, to administer the database and develop a consumer-friendly website. HCCI was founded in 2011 by four insurance companies including Aetna, Humana, and UnitedHealthcare --- all of which write coverage in Florida and have voluntarily submitted the claims.
But other carriers haven’t reported the data because they haven’t been required to do so until this year, after the rules were finalized.
HCCI has extrapolated the data it collects to develop hospital-specific information showing the average costs insurance companies paid for 21 inpatient services and 40 outpatient services.
But without the additional claims data from the other insurers, the state has been unable to produce cost information for nearly one-third of the licensed hospitals in the state.
McManus downplayed the hospital association’s concerns and said the Agency for Health Care Administration will continue to move ahead with the transparency initiative “regardless of the special interest involved wanting this information to be hidden or too complicated for consumers to compare.”
Moreover, she said before the agency launched the website, “consumers did not have access to this information that allows them to make informed choices about their health care.”
But Woods said Florida Blue tries to educate its 5.1 million consumers about costs of care --- as well as their portions of the costs of care ---- in a variety of ways and has made available a cost estimator that it dubs “Know Before You Go.”
The system allows customers to compare medical costs for several procedures, find providers and pharmacies and compare drug prices. It was used more than 193,000 times in 2017 by customers.
The Florida Hospital Association also maintains a website called Missiontocare.org. Since it was launched in 2016, it has had 67,000 views according to association spokeswoman Monica Corbett.