As goes Massachusetts, so goes the nation—at least when it comes to healthcare. In the midst of the debate on Obamacare, I wrote a series of 10 posts examining the Bay State’s 2006 law that served as the blueprint for the Affordable Care Act. It’s time for an update. This is the third of an occasional series about coverage of Massachusetts healthcare. The first installment is here; the second is here.
As I interviewed people connected with healthcare in Massachusetts earlier this year, one name kept coming up: Martha Bebinger, the health correspondent for WBUR. “Martha is the best,” said Steve Walsh, a former state legislator and now head of the Massachusetts Council of Community Hospitals, in a typical comment. “She looks at the marketplace.”
What makes Bebinger’s work stand out? In short, it’s her focus on consumers. In the matter-of-fact, declarative style of a radio reporter, she describes what people are actually experiencing in the healthcare marketplace—and if there are contradictions with what the policy wonks say should be happening, she points them out.
Bebinger’s focus has often been a 2012 state law designed to improve Massachusetts’ landmark health reform legislation, passed in 2006. Provisions in the law called for greater transparency on the part of insurers and hospitals. It’s one of the underlying premises of both the Massachusetts law and the Affordable Care Act: Give consumers information, and they’ll vote with their wallet to bring down prices.
But as WBUR listeners and readers of the station’s “CommonHealth” blog know from Bebinger’s reporting, whatever the laws’ intent, actually getting the information you need to shop for value—and being able to make sense of it—is not easy.
How the issue connects to the consumer, Bebinger told me, is one of the first questions she asks to guide her reporting. She puts herself in the shoes of consumers—and even writes about her own experiences shopping for healthcare. Here are a few of the stories she’s uncovered with her consumer-centered approach:
- Back in early 2012, one of the stories that first brought Bebinger’s work to my attention was about a doctor in Northborough, MA, who after comparing insurance company brochures and websites and constructing elaborate spreadsheets still couldn’t figure out which pricing tier offered by the carriers was best for her family. Wow, I thought—choosing the “best” plan was not so easy, even for a medical professional, even in Massachusetts.
- At the end of 2012, she shopped for an MRI and waded into the thicket of hospital costs, charges, and negotiated rates. A series of migraines gave her the “opportunity to be an engaged, savvy patient,” she wrote. It was not a happy experience. Simply getting the information was a major task. One hospital quoted about $5,000, an independent lab quoted between $2,000 and $3,600, and Newton-Wellesley Hospital, where she had her procedure, didn’t even give a ballpark estimate. In the end the hospital charged her insurer nearly $8,000 for two tests (only one was ordered), plus a fee for reading the test. Her insurer paid $1,360. “This is incredibly confusing and about as far from the transparent process that is supposed to help us ‘shop’ for care as you can get,” she wrote on WBUR’s CommonHealth blog. “Be ready for a long journey that will take some patience.”
- That patience has been tested some more as she made similar frustrating shopping trips for X-rays for a back injury, a colonoscopy, and a bone density test. Late last year Bebinger got the colonoscopy, choosing quality over price, as best she could determine it. She had previously created a rough but useful table showing several quality metrics for different facilities based on data cobbled together from providers and her insurer. “The table was to highlight what we don’t know rather than to imply this was the best information out there,” she told me. Still, it’s a helpful starting point for other consumers.
- In May of this year, she wrote about the 26 steps she took while trying to compare prices for a bone density test at three screening labs, concluding “this is not the transparency promised in the state’s 2012 health care costs and quality law or the transparency that could save billions of dollars a year nationally.” (What comes after step 26? “I give up.”) This case was especially discouraging because just a few months earlier, state regulators had issued new guidelines for both insurers and providers intended to make shopping easier. In Bebinger’s experience, they still didn’t do the job. “That’s why I was so pissed about the bone density test,” she said—and her prose in the story shows it.
On Oct. 1, the state launched another phase of the 2012 law’s transparency provisions. Insurers (but not hospitals) must now disclose prices in real time to consumers on their website and at their call centers.
This may be a step into transparency adolescence, but Bebinger says there’s still no good way to figure out whether the prices match up to differences in quality of care.
Shoppers still can’t really learn which facility is best at performing colonoscopies. “There are very few carrots or sticks compelling providers to disclose how they measure quality or describe their results,” she told me.
There are also questions about enforcement of price disclosures, and whether prices are standardized. The price of a bone density test at one facility may be $116 and $500 at another. But the cheap price, Bebinger explained, may not include the costs for reading the tests or physician fees. Without standardization it’s hard to know who’s offering the best deal.
Transparency in healthcare is a good thing—for consumers, and for journalists. But the transparency movement in healthcare has had as many false starts as real successes. Bebinger’s continued scrutiny of the real-world effects of the Bay State’s transparency law show us that this story is indeed a work in progress. These stories might not be seen as sexy audience grabbers, but Bebinger and WBUR are performing an important oversight role.
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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.