Patient-choice bill gains support in Concord
Rep. Neal Kurk, R-Weare, architect of last year’s GraniteCare law, has introduced another major health-care bill, — House Bill 1723 — which is designed to give patients the kind of information that he hopes could drive down medical costs. The legislation would require doctors, hospitals and other medical providers to let the state know their prices for medical procedures and report the results and dollar amounts of their malpractice cases, even ones that settle before going to court. The latter data would serve as a proxy for the quality of care. Armed with this information on a Web site, the patient could shop for the most able and affordable practitioners and treatment settings, Kurk says, and so could employers looking for the best deals on fringe benefits. At a Jan. 12 hearing, Kurk testified the bill would speed up a promising market trend. He likened health-care purchasing to dining in a pitch-dark restaurant without a menu. The guest eats a meal chosen for him. The bill arrives months later. It is unintelligible. “You get a bill with a bottom line,” he told the House Commerce Committee. “You have no idea what it was for. You went in not knowing what it would cost. The market can’t prevail unless consumers are informed.” Co-sponsor Fran Wendelboe, R-New Hampton, passed around her medical bill for a recent MRI test for one of her family members. The fee to read the results was more than the cost of the exam. “I found that totally astonishing,” she said. Commerce committee members generally liked the concept of the bill, but suggested reworking it to avoid duplication with several existing data collection efforts. Leslie Ludtke, policy analyst for the Insurance Department, said her office already collects most of the needed information on procedures and prices. It would just take a state appropriation to post it. She said her office now posts online some of the consumer-choice information the bill calls for. That site displays average costs for common hospital procedures and the prices at each of the state’s hospitals. The link for comparative quality of care gives hospitals scores for different procedures based on their performance of certain best practices, but that data is not yet outcome-based. Experts testified that the best providers often get the sickest patients. As a matter of fairness, the caseload would have to be indexed to the condition of patients before treatment. Commerce Committee member Martha McLeod, D-Franconia, feared this kind of competition could draw customers away from the small hospitals up north. Kurk said the change might eventually streamline the market as the strongest and most efficient players emerge. Lobbyists from four HMOs listened to two hours of testimony, but said nothing. Leslie Melby, lobbyist for the New Hampshire Hospital Association, said her 32 member hospitals support full transparency, but wanted to avoid duplication in data collection. Kurk said he plans to simplify the bill and let state agencies decide the best way to gather the information. Doug Hall, head of the New Hampshire Center for Public Policy Studies in Concord, told lawmakers he hopes to publish a report on this issue within a month. He suggested gathering data on insurance carriers as well, including their policies and payments for various medical services and procedures. That would tell an employee the cost of care beforehand and the sum their plan would pay.