Legislature(2017 - 2018)GRUENBERG 120
03/27/2017 01:00 PM House JUDICIARY
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| Audio | Topic |
|---|---|
| Start | |
| HB123 | |
| HB42 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 123 | TELECONFERENCED | |
| += | HB 42 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 123-DISCLOSURE OF HEALTH CARE COSTS
1:22:33 PM
CHAIR CLAMAN announced that the first order of business would be
HOUSE BILL NO. 123, "An Act relating to disclosure of health
care services and price information; and providing for an
effective date."
1:23:27 PM
REPRESENTATIVE IVY SPOHNHOLZ, Alaska State Legislature, advised
that the bill is about price transparency and bringing an
element of the free market into the health care marketplace of
which, currently, does not exist. She pointed out that health
care consumers do not know their health care services cost
unless they call and ask for special quotes and rates. Through
this bill, she said, her goal is to introduce more price
competition, open up the conversation about price competition to
compare prices in health care consumerism.
1:24:34 PM
CHAIR CLAMAN referred to a document titled "Top 50 CPT Codes -
Hospital 1," and asked Representative Spohnholz to explain the
document.
REPRESENTATIVE SPOHNHOLZ explained that the list for the top 50
CPT codes most frequently provided was requested of Becky
Hultberg, Alaska State Hospital and Nursing Association (ASHNA).
This is not exactly the manner in which the services would be
listed that the bill requires. She explained as follows:
We actually asked for services listed by CPT code,
which is the designation, is appropriate in the third
column here with a description that is written in
plain language so that a non-medical professional can
understand it along with the undiscounted price. So,
what we're looking at here is a very different sort of
list, it is the CPT code description which is for
billing purposes, along with the CPT code number, and
the number of times this service was offered at this
particular hospital over the last -- the 2016 year.
So, you can see that the vast majority of services
that were offered in this particular hospital were
either labs of some kind, or emergency department
treatments.
1:26:27 PM
REPRESENTATIVE LEDOUX read the title of the second column as
"Charge CPT Code," and whether the [third column - 2016 Count]
was how many times people have had the procedure.
REPRESENTATIVE SPOHNHOLZ responded that the CPT code is the
number used for medical billing purposes, and [the third column]
"2016 Count" is the number of times that service was provided
within that facility.
REPRESENTATIVE SPOHNHOLZ clarified that this description of CPT
is how the medical billing people see them, not as the bill
requires. Also, it is important to note in HB 123 that it
distinguished between individual providers of health care and
facilities. Therefore, a hospital would clearly fall into the
facility category offering more services due to the volume and
the scope of its services, and the bill asks for the top 50 CPT
codes. In the case of an individual medical practitioner, such
as a family doctor, they would list the top 25 most frequently
offered services, and their services could differ depending upon
the medical services offered by each practitioner.
1:28:08 PM
REPRESENTATIVE REINBOLD asked whether their discussion in her
office regarding facilities had been fixed in the bill.
REPRESENTATIVE SPOHNHOLZ referred to the bill, page 2, lines 26-
29, [Sec. 18.23.400(d)], which read as follows:
(d) A health care provider or health care
facility may include a statement with a list published
under (c) of this section explaining that the
undiscounted price may be higher or lower than the
amount an individual actually pays for health care
services described in the list.
REPRESENTATIVE SPOHNHOLZ explained that the bill allowed for a
disclaimer to be included on the price list, and the bill did
not prescribe what that disclaimer should read specifically. In
the case of a community health center with a sliding fee
schedule, the Alaska Primary Care Association wanted to be
certain that potential health care consumers were not scared off
by the undiscounted price listed. The Alaska Primary Care
Association wanted to be able to post that there was a sliding
fee schedule and that the actual price a consumer would pay
would be much different. She offered that this would apply to a
private practitioner's needs, such as indicating they are a
preferred provider or covered under various health insurance
plans.
1:29:55 PM
REPRESENTATIVE REINBOLD referred to the Veterans Administration,
and having the Indian Health Service publish its top 25 or top
50 "expenses, and I would love that ..." In the event everyone
else has that requirement, it is only fair that the government
facilities "expose that, as well."
REPRESENTATIVE SPOHNHOLZ referred to HB 123, Version I, page 3,
lines [24-31, Sec. 18.23.400(h)(2)] which read as follows:
(2) ... "health care facility" does not
include
(A) the Alaska Pioneers' Home and the
Alaska Veterans' Home administered by the department
under AS 47.55;
(B) an assisted living home as defined
in AS 47.33.990;
(C) a nursing facility licensed by the
department to provide long-term care;
(D) a facility operated by an Alaska
tribal health organization; and
REPRESENTATIVE SPOHNHOLZ pointed out that the provision provides
a few exclusions because the health care consumed in those
services was different. She added that it had been brought to
her attention that there could be a separation of powers issue
because the legislature did not have authority to mandate
federally funded facilities.
1:31:16 PM
REPRESENTATIVE REINBOLD reiterated that if the private sector
was under this requirement, it was only fair that the public be
under the same requirement, especially if it was the
government's requirement. She asked Representative Spohnholz to
speak to the issue of possibly being in conflict with anti-trust
laws.
REPRESENTATIVE SPOHNHOLZ responded that she was unsure any
specific antitrust statutes related to this, there was a domain
issue. She reiterated that state governments cannot tell the
federal government what to do; therefore, the legislature cannot
legally require, for instance, the Veterans' Administration to
list its prices. She related that in the event the committee
wanted to propose an amendment changing the body of this bill,
perhaps Legislative Legal and Research Services should be
brought in to consult on that particular element. She
acknowledged that she did not consult with Legislative Legal and
Research Services on that particular limitation because she was
advised by professionals in the field that it was not advisable.
1:32:57 PM
CHAIR CLAMAN pointed out to Representative Reinbold that in
terms of offering an amendment, it would be due by 5:00,
3/28/17. He commented that the issue was not a separation of
powers, but rather "federal supremacy" which meant no state had
the authority to order the federal government to do anything,
and this would not be an exception. Frankly, he said, there was
no basis for Alaska to require federal agencies to disclose that
information.
1:33:39 PM
REPRESENTATIVE REINBOLD said she will look into the issue
because in the event any state dollars were going into these
facilities, it was only prudent for the legislature to be wise.
She opined that a lot of Medicaid state funding does go to some
of these facilities.
REPRESENTATIVE SPOHNHOLZ pointed out that there are facilities
receiving public money that will be required to post their fees,
and there was not a clear bright line between those as it
related to public funding versus not public funding. For
example, she pointed to the community health centers that
receive a substantial amount of funding through Medicaid, and
said they will list their billing amounts.
1:34:46 PM
REPRESENTATIVE REINBOLD asked whether this conflicts with
federal laws because a couple of doctors sent her laws,
although, those laws were not currently in front of her.
REPRESENTATIVE SPOHNHOLZ answered that, to her knowledge, this
bill does not conflict with federal law beyond the
constitutional limitations previously discussed.
1:35:13 PM
REPRESENTATIVE LEDOUX commented that just because she was
insured did not mean she didn't not care about the costs of
service. She offered a scenario of being insured and visiting a
doctor with his rack rates on the wall, and she then checking
with another doctor who has lower rack rates listed. She asked
whether it was conceivable, due to the type of insurance she
carried and the relationship between her physician and the
insurance company, that the doctor with the higher rack rate was
actually charging her insurance company a lower fee than the
doctor with the lower rack rates.
REPRESENTATIVE SPOHNHOLZ responded that it was possible if the
doctor with the higher rack rate was a preferred provider with
her insurance provider, and the doctor with the lower rack rate
was not. In the event they were both preferred providers they
would likely be paid at the same rate. However, she pointed
out, there will be some patients who pay the full rate or pay a
higher percentage of that full rack rate. Yet, posting the full
undiscounted price still has merit because it is the basis for
which all prices are derived.
1:36:56 PM
REPRESENTATIVE LEDOUX said her question goes back to the person
with insurance and why they would care which doctor had the
higher rack rate. In the event both providers were preferred
providers, one could have a rack rate of $200 and the other a
rack rate of $100, and both providers would end up with $50 from
the insurance company. She asked whether she was correct.
REPRESENTATIVE SPOHNHOLZ noted that, in theory, it was possible,
and what Representative LeDoux identified is one of the big
challenges in the health care market place, in which it is
difficult to determine exactly what [amount] would be paid. She
said she does not claim that this bill would solve that problem
because the bill's goal is to help consumers understand that
some health care is expensive, some is less expensive, and to
get more information out to the consumer. It was also designed
to stimulate a conversation between individual health care
consumers, the billing departments, and their doctors.
REPRESENTATIVE SPOHNHOLZ said that in following up on the
3/24/17 discussion, a letter was received from Jeff Ranf, Co-
Chair of the Legislative Community Committee, Alaska Association
of Health Care Underwriters. Mr. Ranf reminded the committee
that it was not always clear to individuals that someone was
paying full freight even if they were not paying full freight.
Due to the fact that health care costs are dramatically
increasing, there is disconnect between the end user of health
care services and those charging for it. Representative
Spohnholz described this bill as one tiny step forward in the
first mile of a long-term marathon in trying to reduce health
care costs. This bill is simple to implement, a simple strategy
to understand, and it will help inform conversations and dialogs
about health care costs, she explained.
1:39:57 PM
REPRESENTATIVE KREISS-TOMKINS said he appreciates the place the
bill is trying to get to, but he is also cognizant of the legal
realities.
1:40:37 PM
REPRESENTATIVE EASTMAN asked the sponsor to offer an
understanding of "how it is that we get here" with health care
and the lack of transparency. He further asked why it was that
health care traveled down such a different road than other
services to then get to the point of passing a bill like this to
fix it.
REPRESENTATIVE SPOHNHOLZ related that that's a big question and
posited that the journey into opacity in health care pricing
occurred when health care insurance was first introduced. The
first provider of health care insurance was what is now Premera
Blue Cross, a group of doctors came together to put together a
funding structure that made it more affordable for regular
working people to get health care and afford their services.
She opined that that was a laudable goal in financing for health
care, but that was the beginning of separating the consumer from
the person selling the services. Since that time, the market
has gotten more complex with more payors in the market adding to
its complexity, and "anytime you're not actually looking at the
actual cost and paying attention, you are more likely to not pay
attention to the cost" such as, certain young people with their
first credit card, she offered. Her hope, she said, is to shine
a little more light on the costs of health care, and she looks
forward to advancing other bills approaching the issue from a
different tact.
1:43:44 PM
REPRESENTATIVE EASTMAN asked that since most consumers of health
care in Alaska fall under some kind of private or government
sponsored health care program, and insurance sets those costs,
whether she had considered hitting it dead on and going after
the insurance costs side of things and the need for
transparency.
REPRESENTATIVE SPOHNHOLZ said that she had considered his
suggestion and it would possibly be a bill for another day.
1:44:59 PM
REPRESENTATIVE REINBOLD, in response to Representative Eastman,
offered that previously she was the operations manager for
Medical Park Family Care, and that it was difficult to quote a
price at someone's request. For example, a person may say they
have a sore throat when in reality they have more complicated
issues they are not comfortable telling the receptionist. Once
the patient was before the doctor, five or six other issues may
come up that required a shot or whatever. She said that vaccine
charges change often, insurance plans change regularly, and
sometimes people come in as a veteran, under TRICARE, or due to
a car accident. She related that Medical Park Family Care
charged different prices when it was an automobile accident, or
workers' compensation', or a contract with unions, or state
employees, and it was complicated to determine the fees for
"twenty different things" in a comprehensive exam.
1:46:50 PM
CHAIR CLAMAN commented that Representative Reinbold's comments
were far afield from this bill.
REPRESENTATIVE KREISS-TOMKINS noted his appreciation to ASHNA in
providing the top 50 most common CPT codes.
CHAIR CLAMAN said he found the confusion of price between
Hospital 1 and the unidentified hospital interesting, and noted
that a complete blood count was the most common procedure.
[HB 123 was held over.]