There is an increasing movement toward pricing transparency for hospitals and providers. As previously reported in theABCNewsletter, the Centers for Medicare & Medicaid Services has released massive databases with information on Medicare payments to hospitals, physicians, and other non-hospital providers. In addition, three large insurers have announced that they are establishing a similar online database of paid claims. Also evolving very rapidly are state-level All-Payer Claims Databases (APCDs). More than 30 states have established or shown a strong interest in APCDs, large databases that systematically collect medical claims, pharmacy claims, and provider files from private and governmental payers to obtain multipayer data that allow stakeholders to understand the cost, quality, and utilization of health care in their region.
Collecting and sharing raw data is one thing. Aggregation and interpretation is another, and in this context there are many technical and political challenges. To turn data into information, users must have sophisticated analytic capabilities, which many consumers, blood centers, providers, and hospitals may lack. Once the ability to mine data is available, blood bankers may be concerned that growing healthcare price transparency may be misinterpreted and drive margins down. While national healthcare organizations are just beginning to use comparative cost information to select blood suppliers, the momentum may be at hand.
There are ways to prepare for pricing transparency but in most cases, since blood centers already provide high quality at what they consider competitive prices, the preparation may be painful.
What hurts blood centers is that they do not necessarily know how their prices stack up against competitors, nor do they know how much their hospitals charge for their products. Unfortunately, detailed cost reports of the future may not make the public aware of the difference between what the hospital charges for blood transfusions and the cost that the hospitals pay to blood centers for blood products.
Blood center leaders owe it to themselves to try to make these comparisons and understand how they stack up against the competition. And competitors are not just local anymore – they are national. Blood centers should also analyze the public data to determine how costs are being represented vis-à-vis hospital charges.
Lastly for the 20,000-ft. view, blood centers can look to the international perspective through the annual Horizon Scanning document created by the Alliance for Blood Operators (ABO), of which ABC is a member. (Last year’s report is available to ABC members only at http://bit.ly/1ocKAT7; the 2014 report will be added to this page soon.) The adage “all health care is local,” is an anachronism in the 21st century, having been replaced by “the world is flat.” Global enviroscanning and insights may provide a guidepost in staying one step ahead as health care data transparency continues to develop.
Christine S. Zambricki, DNAP, CRNA, FAAN, Chief Executive Officer; firstname.lastname@example.org