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Payer claims transparency: Essential or counterproductive?


Debate continues about whether releasing healthcare provider payment data publicly is a good idea: Proponents say it will show taxpayers where their healthcare dollars are spent and how provider choices affect their pocketbooks. Opponents say, besides misleading the public, releasing payment data may increase healthcare costs.

Since consumers seldom know how much they'll have to pay for health services before receiving them, Colorado created an all payer claims database enabling customers and employers to track healthcare costs, according to KREXTV.

"We need to find a way to deliver care more efficiently," Rocky Mountain Health Plan CEO Steve ErkenBrack told KREX. "[W]hen healthcare starts costing more than your mortgage does, people are going to care where those dollars are going, and they should care," he said.  

But other experts have voiced concerns about all payer claims databases. For example, doctors may learn their peers are out-earning them and demand comparable fees from insurers, which will contribute to premium increases, reported MedPage Today.

"Collecting reams of data without specific purpose puts unnecessary burdens on governments collecting that data, and on health plans that must provide that data," AHIP Executive Vice President for Policy and Regulatory Affairs Dan Durham said Monday at the National Summit on Health Care Price, Cost and Quality Transparency, MedPage Today noted. "Releasing large amounts of such data without considering the competitive dynamics could actually have the opposite effect that we're trying to achieve and probably drive prices higher."

And prior data transparency efforts have had disappointing results: Though some states operate websites that post prices of hospital care, these sites omit insurance information and are not particularly helpful to consumers.

Results of a recent poll show doctors have mixed opinions about releasing payment data, with 46 percent in favor of keeping Medicare data private, 42 percent supporting public release and 12 percent undecided.  

Finally, there's concern that Americans will misunderstand and misuse payment data, MedPageToday noted, leading to doctor bashing.           

For more:
- read the MedPage Today article
- see the KREX story

Related Articles:
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