WASHINGTON — Price transparency for physician and hospital services is a key element in the Bush administration's vision of “consumer-driven” health care, and the administration is prepared to push for mandatory price-tagging if doctors and hospital administrators won't voluntarily provide the information.
Speaking at a health care congress sponsored by the Wall Street Journal and CNBC, Al Hubbard, assistant to President George W. Bush for Economic Policy, issued a kind of ultimatum to the clinical community: “Make pricing information available without being forced. If you do not do so, we will force you to. We have allies in Congress who are very much inclined to be prescriptive with legislation to impose pricing and quality standards on the health care community.”
Comprehensive and accurate pricing for health care services are essential for the efficacy of health savings accounts (HSAs) and other market-driven solutions to the health care cost crisis favored by the administration and many business leaders, said Mr. Hubbard, who is also director of the National Economic Council, at the meeting.
“Under a consumer-driven health care system, the consumer is incentivized to become a smart shopper, and a driver to push prices down and quality up,” he said. He cited LASIK (laser in situ keratomileusis) surgery as a prime example. “Fifteen years ago, LASIK cost about $2,500 per eye. Because the service is an out-of-pocket expense, now the cost is under $1,000 per eye. That's what would happen in the rest of health care if people were price-sensitive consumers.”
According to Mr. Hubbard and others within the Bush camp, there's one major obstruction on the road to a consumer-driven health care utopia: the absence of pricing and quality-rating information for medical services.
“You cannot be a wise consumer if you don't know the prices or the quality of the goods. Right now, providers do not make that information available, and a lot of hospital executives don't believe pricing information should be available,” he said.
Mr. Hubbard's remarks followed a very brief and fast-spoken video address by President Bush, in which the president underscored his commitment to HSAs as a key instrument for change. He estimated that more than 3 million Americans will be enrolled in HSAs this year, a number he hopes to see vastly increased over the next few years.
The president underscored the “simple and clear philosophy” that underlies his solution to the health care problem: “The American medical system should be run by doctors, patients, and consumers, not the federal government.”
It was easy for Mr. Hubbard to talk tough at the meeting. According to the conference organizers, physicians represented only 4% of attendees, and there were very few doctors in the room during Mr. Hubbard's address.
One physician, an anesthesiologist, did stand up to challenge the administration's fixation on price-tagging.
He cited the potential dangers that could arise if “consumers”—that is, patients—began choosing health care services based on price postings. He stressed that the medical community itself is far from having accurate quality measures to determine standards for best practices. Without clear and science-based quality standards, pricing information would have little value because patients would not be able to determine what they would be getting for their money. Further, shopping for health care based on price could encourage substandard care and suboptimal clinical outcomes.
He also pointed out that a higher-priced physician practice or hospital may be incurring those higher costs because they are treating a sicker population. Likewise a practice or hospital with lower outcomes scores may be handling sicker patients. Price tags and raw outcomes data alone would not reflect this, unless accurate risk-stratification measures were also incorporated.
Mr. Hubbard acknowledged that there's much work to be done in developing meaningful outcomes standards and risk assessment tools so that consumers can “compare apples to apples.” At the same time, the administration seems unwilling to wait around indefinitely while practitioners and hospitals figure out how to prove their worth.
Several in the audience pointed out that the “shop-around” approach is likely to break down around episodes of emergency care, critical care, and sudden onset of disease.
An individual having a myocardial infarction isn't likely to consult the Internet to find out which area hospital offers the best dollar value.
The unflappable Mr. Hubbard agreed that emergency situations are an exception to the consumer-driven rule, but he insisted that “there's no reason we should not be able to have bundled pricing from our physicians and hospitals on all nonemergency care. We want you to treat your patients/customers exactly the way you want to be treated when you consume a product or service.”