By Richard Asinof
PROVIDENCE – Leaders of the Rhode Island Health Insurance Small Employer Taskforce are calling for greater transparency in health care provider finances following the release of national data for the top 100 most frequently billed procedures under Medicare.
The analysis, done by the Centers for Medicare and Medicaid Services, details the differences between payments and charges by hospitals under Medicare for fiscal year 2011.
Broken down by states, the data “show significant variation across the country and within communities in what hospitals charge for common inpatient services,” CMS officials said.
Stephen C. Boyle, president of the Cranston Chamber of Commerce and a leader of the small employer task force, said the data showed the great disparity between hospitals here in Rhode Island.
“For years, we have been saying that health care costs were unpredictable and too high,” Boyle said. “And now, the data prove that what an insurer can pay for the exact same procedure depends on the hospital in which it takes place – and those hospitals can be in the same hospital system.”
As employers, Boyle said that much more transparency was needed in Rhode Island’s system. “If I need to buy a tool, I can find out what it costs at the local hardware store or the one across town and make my decision. But I have no such power when I buy health care services – and that needs to end.”
For instance, in Rhode Island, for hip and femur procedures (billing code 481), without a major joint but with complications or co-morbidities, what the hospitals charged Medicare, and what they were paid, varied greatly:
Even worse, according to Boyle, is the fact that people who are not insured, or who are not fully insured, end up paying a larger portion of the bill than those with better health insurance. “People who can least afford it are often the ones paying a higher rate,” he said.
Boyle promised that the small employer task force “will be raising the disparities uncovered by this CMS report” throughout the current insurance rate review process.
“For far too long, insurance prices have been too high, and we have had no real recourse over what seem like arbitrary increases,” Boyle said. “The data help us see what we need to do to solve this problem.”
Spokeswomen from Lifespan and Blue Cross & Blue Shield of Rhode Island were not available to offer any comment on the CMS data showing disparity in hospital charges and reimbursements.
To view the entire database for Rhode Island, click HERE.