Patient billing protections, 'fair reimbursement' among recommendations in new report from Massachusetts health commission

A Massachusetts commission has released a new report that provides 11 policy recommendations, including enhancing out-of-network protections for patients and addressing provider price variations.

The report from the Massachusetts Health Policy Commission recommends requiring that patients be warned before they use a provider that could be out of their insurer's network; setting "a reasonable and fair reimbursement" for out-of-network services; and establishing patient billing protections in emergency and "surprise" billing scenarios.

The commission also recommended addressing variation in prices paid to healthcare providers for the same services. The commission said policymakers should "advance specific, data-driven interventions to address the pressing issue of continued provider price variation in the coming year."

These and other recommendations came after the commission found that:

  • Total 2017 healthcare spending in Massachusetts grew 1.6 percent per capita, down from the 3.6 percent healthcare cost growth benchmark the commission set.
  • Prescription drug and hospital outpatient department spending grew 4.1 percent and 4.9 percent respectively in 2017. This made these the highest spending growth areas, although the increases remained below rates the year prior.
  • In 2017, people with employer-based insurance earning between 139 percent and 299 percent of the federal poverty level spent about one-third of their total income on healthcare. This includes spending on premiums as well as out-of-pocket spending and taxes for state and U.S. healthcare programs.
  • Average prices for hospital inpatient care among the three largest commercial insurers in Massachusetts were 57 percent higher than Medicare prices for similar patients. The commission said commercial insurers also paid higher prices for typical outpatient services, including brain MRIs, emergency department visits and physician office visits.
  • Commercial insurer and Medicare prices also varied. According to the commission, commercial insurers paid the highest-priced hospital 2.7 times more per discharge compared to the lowest-priced hospital. Medicare paid the highest-priced hospital about 1.5 times more per discharge than the lowest-priced.

Access the commission's full report here.


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Loretto Hospital Chief Treasury Officer Kenneth McGhee on creating new revenue streams

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