This month a new health cost transparency law took effect in Wisconsin. The law requires:

  • Hospitals to share median charges and estimated payments for private insurers and Medicare for the 75 most common diagnoses and the 75 most common outpatient surgical procedures.
  • Physicians and other health providers to release similar cost information for the 25 most common conditions, beginning March
  • Other health providers are subject to the bill’s requirements, but are not included in the state’s implementation plan for 2011.
  • Hospitals and clinics to let patients know how to obtain quality data if they report it to quality organizations.
  • Hospitals and clinics to post signs in prominent locations about the right to receive this information.

Since disclosure of cost and quality information is central to the mission of The Alliance, we were asked to provide input to help shape the bill. Feedback from The Alliance Health Policy Committee was reflected in the final version, however the final law fell short of providing the information consumers really need to make informed health care decisions. Ideally, consumers would have one Web-based resource to enable them to compare meaningful cost and quality information from provider-to-provider and hospital-to-hospital.

What about Quality?

Information about cost without information about quality can be misleading. In health care, cost and quality are not correlated — and as we’ve seen in our own QualityCounts™ reports, high-cost providers do not necessarily deliver the best quality care, nor do low-cost providers deliver poor care. The new law gives a nod to quality information by requiring that if a provider submits data to a “health data organization” and if that data is then publicly reported, the provider is required to either share the information by attaching it to the financial information or by providing a Web address where the results can be found. This voluntary, self-reported process creates the potential for providers to “cherry pick” the quality information they disclose to consumers.

We will continue to work — inside and outside of the Capitol — to improve the transparency of cost and quality information and to develop strategies to promote its use. If you have any questions or comments about the new law, please contact me.

New Resources to Track PPACA Administrative Requirements and Ensure Your TPA is Too

We’ve a created a new resource to help you manage many of the administrative requirements addressed in the Patient Protection and Affordable Care Act (PPACA). The PPACA Administrative Requirements document is also meant to be a starting point for a discussion with your third-party administrator or other benefits partners to determine what requirements are being managed and what areas will need to be in the future. We will update the document as PPACA rules are updated and we’ll be looking for your feedback and to hear from you on how you are using it.We’ve also created a spreadsheet (.xls) to help you keep track of actions that have been taken on PPACA issues. The documents will be permanently available on the PPACA Updates page of our website.