News

U.S. Rep. Bucshon says patients should know cost of treatments

Dann Denny

04/25/2014

April 25--U.S. Rep. Larry Bucshon, R-Ind., said patients have a right to know ahead of time what it would cost them to undergo a particular surgery or treatment, adding that if such pricing was made available throughout the health care system, it would enhance competition and drive down the cost of health care.

"No one knows what anything costs in health care," said Bucshon, a cardiothoracic surgeon serving his second term in Congress representing Indiana's 8th District, which includes Owen and Greene counties. "I used to ask hospitals what it would cost them for me to do a three-vessel bypass, and they wouldn't or couldn't tell me. And the patient has no clue what things will cost."

Bucshon was speaking to a group of mental health and health care professionals and advocates as part of a seven-member panel discussion Thursday morning at Centerstone. The 75-minute discussion focused on mental health issues and health care in general.

One of the panelists, state Rep. Tim Brown, is joining Bucshon on a two-week tour to nine cities across the state, called the Hoosier Healthcare Tour, for the purpose of discussing the status of health care in Indiana. Brown, a practicing emergency room physician, has served the General Assembly since 1994, representing House District 41. He's chairman of the Ways and Means Committee.

"If you were buying a certain make and model of a car, you would have a ballpark idea of how much it would cost, but health care pricing is so nebulous you would have no idea," Bucshon said. "But if pricing transparency became ubiquitous throughout the health care system, you would create competition that would bend the cost curve down."

He said Lasik eye surgery, which is not covered by insurance, cost $4,000 for both eyes a decade ago.

"But today, due to competition, it costs $600 to $700," he said. "The equipment and the surgeons are better, and the patient benefits from that competition."

Bucshon said another way to reduce the cost of health care is to provide consumers with "risk stratification" data on the performance of health care providers.

"Risk stratification takes into account the percentage of high-risk patients providers are treating," he said. "It you just release raw data, it won't be meaningful, because one provider might have a higher mortality rate because he's doing a lot of heart surgery on high-risk patients."

Bucshon said if risk stratification data is made available to consumers, they will seek treatment from the best doctors and eventually drive the poor ones out of business.

"The public wants this data, so it's going to happen," he said. "There's no reason why the best heart surgeon in the country and the worst heart surgeon in the country should be paid the same for doing the same procedure. If everyone is paid the same, there is no incentive to be good."

When asked about the feasibility of expanding Medicare to cover every American, Bucshon said according to the Medicare's "actuarial report," the number of seniors needing Medicare by 2030 will nearly double to 70 million; and by 2024, the Medicare trust fund will be at zero.

"Imagine that you have a savings account and a checking account, and every month you have to transfer money from your savings to your checking to pay your bills," he said. "That's what Medicare is doing every year, to the tune of about $35 billion a year. When the balance reaches zero, we as a society will have some tough decisions to make about Medicare."

Bucshon said the government could start funding Medicare with the general fund that's used for discretionary spending, or dramatically cut Medicare reimbursements to medical providers.

When asked what can be done about Medicare's stagnant reimbursement rates to providers, Bucshon stressed that Medicare needs to be reformed.

"There are differences in opinion on how to do that, but we need to find some common ground, because it has to be reformed to make it sustainable for our current seniors and future generations," he said. "This is not my opinion. It's accounting reality based on data from the government's actuarial report."

Bucshon said until Congress reforms Medicare, health care providers will continue to see reimbursement cuts.

He said pediatricians and mental health providers have been dealing with inadequate Medicare reimbursement rates for years, and other specialists are now seeing their rates sink as well.

"It all honesty, those cuts are the most politically palatable because most people feel physicians can afford those cuts," he said. "But it's a fine balance, because we have to keep the reimbursement rate high enough to continue to produce doctors. We have to ask ourselves what level of Medicare reimbursement young people will think is sufficient for them to pursue a medical career by spending four years in college, four years in medical school, and three to seven years of residency training."