A present for all Ohioans starting Jan 1, 2017

Maybe when you read about this in the Dayton Daily news next week, they may give credit to who broke this story for them. Hah.
Yesterday, there was a front page article about the Veterans Service Commission appointment– a full 6 days after I wrote about it and gave you all the documentation.

There was also an article about new laws on the books– but they missed this on- pushed by local state rep Jim Butler:

O.R.C. 5162.80 [Effective 1/1/2017] Good faith estimates for charges and payments.

(A) A provider of medical services licensed, accredited, or certified under Chapter 3721., 3727., 4715., 4725., 4731., 4732., 4734., 4747., 4753., 4755., 4757., or 4779. of the Revised Code shall provide in writing, before products, services, or procedures are provided, a reasonable, good-faith estimate of all of the following for the provider’s non-emergency products, services, or procedures:
(1) The amount the provider will charge the patient or the consumer’s health plan issuer for the product, service, or procedure;
(2) The amount the health plan issuer intends to pay for the product, service, or procedure;
(3) The difference, if any, that the consumer or other party responsible for the consumer’s care would be required to pay to the provider for the product, service, or procedure.

Source: Lawriter – ORC – 5162.80 [Effective 1/1/2017] Good faith estimates for charges and payments.

Imagine this- except in an emergency, hospitals and doctors who have already negotiated different prices with different insurance companies what to charge you for a procedure- will actually have to tell you in advance how much they will bill, how much the insurance will cover- and what you will be stuck with.

This gives you a way to shop for that appendectomy next time- if you can wait a few hours.

It costs nearly $6,000 more, on average, for an appendectomy in Dayton than it costs for the same procedure in Cincinnati, even though the cities are less than a hour’s drive from one another, according to a study released by the nonprofit Health Care Cost Institute.

The 2015 Health Care Cost and Utilization Report found vast disparities in the prices of medical procedures from city-to-city and state-to-state based on actual claims data from some of the nation’s largest health insurers.

While the average cost to have an appendix surgically removed in Dayton is $17,967, you can have the same procedure done in Cincinnati for $12,254, according to the report. Meanwhile, the average cost of an appendectomy in Columbus is $15,290.

Source: Medical costs vary sharply, study says

Of course, the hospital association- a powerful lobby in Columbus, is doing everything possible to stop this law from going into effect.

UPDATE

1pm Christmas day- oops, I missed it- they already filed a lawsuit and have an injunction banning the law from taking effect until Jan 20, 2017

In Dayton Ohio, we’re getting screwed. Between Premier Health and Kettering Health- we have a duopoly working together through their illegal trade association the Greater Dayton Area Health Assoication- GDAHA– to fix prices and drive competition away, while they force every private practice into their pockets.

In a universe, now far far away- this was called racketeering- and monopolization- and the federal government used to prosecute businesses that did this.

The simple solution is to start putting price controls in place on organizations that receive more than 40% of their revenue from federal or state funds- especially ones that claim non-profit status,  limiting payroll with a severe income tax. I’m sorry, running a hospital doesn’t entitle you to $4 million a year when the president of the United States only makes $400K a year.

Of course the first company to go into shock would be CareSource- which is a privatized way of using public dollars to provide health care- which could easily be solved with just expanding medicaid for all/Single Payer – and get on with it. I’ve yet to read a story about an insurance executive (or for that matter- a hospital executive) saving anyone’s life.

Forcing the posting of the true price of any service in the health care industry isn’t new, it’s just new to Ohio. We have laws about car repair quotes, we have laws about the shelf prices in grocery stores, and while having a good faith estimate in advance of care is a great start- what would be even better is requiring actual prices to be 100% posted online- allowing real cost comparisons, as well as stopping the illegal collusion between health care and insurers of creating different prices for the same procedure depending on the deal your insurer has worked out.

Even so- a big thanks to Rep. Butler for forcing at least this first step to health care transparency.

 

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7 Comments on "A present for all Ohioans starting Jan 1, 2017"

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Bubba Jones
Bubba Jones

Damned Republicans! I can’t believe one of them pushed something through that Esrati actually approves of!!  Oh, well – this is the season of miracles! :)

 

Merry Christmas to everyone that frequents Esrati.com as well as to our host!!

Scott Newton
Scott Newton

I think we need to move toward more privatization of health care, with some serious reform to malpractice insurance and liability. The federal government, or state for that matter, had not nor will ever manage a health care program well, in my opinion.

Michael D

Nice work David.  Pricing transparency is a must to bring some economic reality to healthcare.  I advocate for this continually at the university healthcare system I practice at in Pennsylvania.

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