Lawmakers discuss potential creation of all-payer claims database

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Employers, health insurers, health care providers and state lawmakers all say they interested in finding ways to slow the rising cost of health care. Creating an online pricing transparency portal could be one step they take in that effort.

The Indiana House Public Health Committee on Wednesday discussed legislation that would create an all-payer claims database and require health care providers to give patients a “good faith” cost estimate of non-emergency procedures in advance, if requested by the patient.

Author of House Bill 1005, Rep. Donna Schaibley, R-Carmel, said there is increasing frustration about high health care costs, and an all-payer claims database could help inform future policy decisions and enhance transparency.

“The goal of this legislation is to make sure the billing process is very clear,” Schaibley said.

The Indiana Department of Insurance would be responsible for issuing a request for proposals to find a third party to establish the database, which would have to be in place by 2022, according to the bill.

The information made available in the database would be provided by health insurers and would allow anyone to see how much certain procedures previously cost from specific providers. For example, someone could see what a MRI had cost at a hospital in Indianapolis compared with a hospital in Carmel.

The idea is that the database could help individuals shop around for the best price. That could save patients money, and potentially save their employers and health insurance companies money, too. It could also help push prices down in the long run as providers try to be more competitively priced.

Schaibley said 26 states already have similar databases.

Colorado’s database allows the public to select a service and input a zip code to see the average price and price range by facility. The average price for a hip replacement at Boulder Community Health Foothills Hospital is $35,450, while the average price is only $15,520 at the Orthopaedic and Spine Center of Southern Colorado, for example.

The issue of high health care costs has become a priority for Indiana businesses as the expense continues to increase for companies. A recent Rand Corp. study showed that Indiana had the highest hospital care costs when compared to 25 other states.

Employers’ Forum of Indiana CEO Gloria Sachdev said medical costs are affecting employee wages, because businesses have to use money that could otherwise go toward salaries to pay rising insurance costs.

“If we want to solve this and address health care costs and prices specifically in a fair market way, we have to have price transparency,” Sachdev said. “The fair market only works if you get to choose.”

Monarch Beverage Co. CEO Phil Terry, who supports the bill, said health care has become the third highest expense at his Indianapolis-based company, behind paying for the products it distributes and employee salaries.

“We pay more for health care than we do for trucks,” Terry said.

The Indiana Association of Health Plans and the Indiana Hospital Association both generally support the legislation but requested a few tweaks be made before final passage.

“We absolutely have to do something. We recognize that,” Brian Tabor, president of the Indiana Hospital Association, said. “I think the all-payer claims database will position us very well for the future.”

The bill also requires health providers to give patients a “good faith” cost estimate for non-emergency procedures, if requested, and provide notice in a facility’s waiting room or website that such estimate can be made available.

The committee did not vote on the bill Wednesday, but it is expected to be discussed and amended next week.

Also during Wednesday’s meeting, the Public Health Committee approved House Bill 1006, which would increase the smoking and vaping age from 18 to 21.

The bill’s author, Rep. Cindy Kirchhofer, R-Beech Grove, said even though the federal government has raised the legal age to 21, the state still needs to take action because it is responsible for enforcement.

The bill increases the fines retailers would have to pay for selling tobacco products to underaged customers.

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