Understanding Limitations on Price Transparency

Interim Hearing on Data Collection and Price Transparency by David Bryant, MD

Senate Health and Human Services Committee
March 21, 2017

Thank you, chairman and members of the Senate Health and Human Services committee, for allowing me to testify.

My name is Dr. David Bryant, and I am an anesthesiologist from North Texas. Today I am testifying on behalf of the Texas Medical Association and its now more than 50,000 physicians and medical students, as well as the Texas Society of Anesthesiologists.

TMA and TSA believe it is important that patients have the proper tools to make the best health care decisions possible. Our organizations have spearheaded many pieces of legislation to this effect (slides 1-4).

Additionally, initiatives we pushed last session that did not pass would have better informed patients about the insurance products they were buying and allowed for more network oversight of health plans being sold to consumers (slide 7). 

When evaluating price transparency on the physician’s end, it is important to understand limitations that come with the concept.  

A patient is a unique individual with specific needs and ever-changing health circumstances. Because of this, physicians and health care providers must have flexibility in providing charge estimates for patients who seek care.

Anesthesia is not billed like other physician services. It’s like the difference between paying for a bag of chips and paying for gasoline for your truck. If you want to buy a bag of potato chips, the cost for an eight-ounce bag may be higher for Kettle Chips than for Lay’s, but you can still be quoted ONE PRICE for each bag of chips. However, if you ask a gas station attendant how much it costs to fill up your truck, the attendant will ask, “What grade are you buying, and how much of it do you need?” 

Anesthesia is billed on an algorithm that considers risk factors for anesthesia: whether it’s an emergency case; age; and most importantly, how long the patient needs anesthesia. The more complicated the case, the higher the level of care the patient requires. And the longer the surgery, the more anesthesia services the patient will consume — how much more is unknown in advance because different surgeons take longer or shorter to do the same procedure. Their bill does not change based on time, but the anesthesiologist’s does because it’s based on consumption of services. Therefore, anesthesiologists can tell you how much a gallon of “gas” MAY be, based on a multitude of factors, and can estimate how much your cost will be, but until you fill up your tank, they will not know.

Additionally, the physician is only one part of the equation. Physicians and their practices do not control and do not always know the details of a patient’s health plan, such as a patient’s maximum allowable.

To have the full equation of what a patient may owe — or a reasonable estimate — the health plans must also contribute information, and must update their network directories more frequently so patients know if physicians and facilities are in or out of network.  

In regard to the data collection and information that the Texas Department of Insurance and the Texas Health and Human Services Commission currently provide, TMA does not have any continuing coordination with either agency in this effort. Some states, however, such as Wisconsin, have adopted an independent, voluntary submission entity for data collection that uses the state medical society as one of the stewards of the data along with other stakeholders.  

As a recap, information and education for patients on the health care coverage they are purchasing is critical to proper decisionmaking when seeking health care.  

For physicians, providing price transparency is complicated by individual patients’ health needs, avoiding delays in care or treatment, and overly burdensome administrative procedures that take time away from our ability to treat our patients.   

Thank you for allowing me to testify today. I am happy to answer any questions.

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Last Updated On

May 09, 2018