CLEVELAND — In our ongoing effort to investigate medical pricing and allowing you, the patient, to see your actual costs, News 5 Investigators turned to Columbus, where a bill that could help is gaining momentum. It’s called Ohio House Bill 49, and it aims to make hospital prices transparent by state law and not just a federal rule.
It also calls on the Ohio Department of Health to enforce price transparency, and it prohibits non-transparent hospitals from sending patients to collections.
HAND 'SURGERY?' AND THE PRICE CHANGES
“I’m physically using my hands to cut, to cut the tools, resharpen them,” said Fred Lloyd, 59, from Stow. He’s a machinist. So, when his right thumb started hurting a while back, he had surgery on it. Then, more recently, when his left thumb had the same kind of issue, he went to the doctor.
“The visit went down the same way it did 10 years ago when I had this one done,” he said, pointing to his right thumb.
“So, you didn’t think anything of it?” we asked.
“No,” said Lloyd. “I had no reason to.”
He said he got a shot for the pain similar to the other hand years ago. However, this time, the price of the shot changed, and it wasn’t covered by his co-pay either. “Had I known that, I’d not gotten the shot,” said Lloyd.
“Too much money?” we asked.
“Oh, way too much money,” he responded.
His wife Elaine was the first to see the bills.
“And then I notice it’s saying surgery — bone and muscle. What kind of surgery is this?” she told us.
The bill showed the shot was labeled a surgery. The Lloyds owed nearly $600 after insurance.
“What does that 600 bucks mean to you?” we asked.
“That’s a couple car payments,” Elaine told us.
OHIO BILL FIGHTS FOR TRANSPARENCY
Republican Ohio State Representative Ron Ferguson is one of the primary sponsors of House Bill 49.
“We want to make sure that it says in Ohio law this is the law. This is what you should follow,” he said. “We want a functional marketplace, and if you don’t have prices, you can’t possibly have a functional marketplace.”
Representative Timothy Barhorst, also a Republican, is the other primary sponsor.
“Without transparency, we can’t fix anything,” Barhorst said. “I would love to help the systems get compliant, not just turn them over to regulators to enforce them with teeth. It needs to be a team effort,” he said.
MEDICAL PRICE TRANSPARENCY IS GOOD FOR OH
Plenty have testified House Bill 49 is good for Ohio, including people from statewide organizations.
“Transparency prevents price gouging and protects patients,” said Charlotte Rudolph from the Universal Healthcare Action Network of Ohio during a recent Ohio House Criminal Justice Committee hearing.
“Ohio lawmakers can give patients more control,” said Dr. Heidi Overton from the America First Policy Institute during the same meeting.
Even a patient who drove in from Cincinnati told members he was shocked when he was asked to pay more just to get a detailed bill of his surgery, “if I agreed in writing to pay a research charge of $300 per page for all the work product that they would generate,” said Drew White.
The bill passed through committee 10-1. Representative Tom Patton from Strongsville voted no. He didn’t go on camera. He sent a statement that said, in part, the Ohio Hospital and Children’s Hospital Associations “opposed the bill in its current form.”
HOSPITALS FIGHT BILL AND OHIO TRANSPARENCY
We asked both associations to explain on camera. Both declined. The Ohio Hospital Association has said, in part, “federal enforcement and penalties have proven very effective at motivating compliance.” However, records show that 2.5 years after the federal transparency rules went into effect, only four fines have been handed out to non-compliant hospitals, yet 730 warning notices were sent. Thee association said a recent sample showed 70% of hospitals are compliant in the U.S. Not everyone agrees.
“Their numbers don’t add up, and their website assessment should, by no means, be misconstrued for a compliance review,” said Ilaria Santangelo from the medical price transparency watchdog group PatientRightsAdvocte.org. “And by their own admission, 30% of hospitals nationwide would be 1,800 hospitals they’re still not fining for non-compliance,” she added.
The Ohio Hospital Association also said, in part, that the Ohio law would “impose a substantial administrative burden on hospitals.”
“Many of the largest institutions and most egregious defenders of (lack of compliance) continue to build, expand, acquire, invest,” said Christine Deacon, who is the Former Director of the New Jersey State & School Employee Health Benefits Program during her HB 49 proponent testimony.
And the association said an Ohio price format different than the feds “will create confusion…,” which begs the question — is the current state of medical pricing crystal clear or confusing?
“They told me that that level of detailed billing was impossible, literally impossible,” said White during his recent testimony.
“We’re middle-class working people that need to know what is going to come out of our pocket,” said Elaine Lloyd.
“(Hospitals) can just go, 'Whelp, that’s it. Here’s what you owe,'” said Frank. “And before you know it, you’re turned into collections because you can’t afford the bill you didn’t know you had.”
Rep. Ferguson said the next step for HB 49 is a floor vote. The Ohio Hospital Association said the bill creates “virtually no additional benefit to patients.”
Other states like Colorado and Texas have passed similar bills to HB 49 this year.
Rep. Tom Patton statement sent to News 5 Investigators:
“I do believe there’s merit to the legislation, but in listening to the committee testimony from the Ohio Hospital Association and the Children’s Hospital Association, they opposed the bill in its current form on the belief that it could create duplicative, complex, and costly state regulations. It’s my thought that the bill has good ideas, yet more time was needed for the bill sponsors and the hospitals to work together on a path forward to create increased price transparency for Ohioans.” - OH Rep. Tom Patton
