Medical cost transparency

A new Wisconsin law will enable patients to obtain more information about the costs of the health care they receive.

The Wisconsin Health Care Transparency law, adopted by the legislature and signed by Gov. Jim Doyle in March, requires health care providers, hospitals and insurers to disclose procedure pricing information to consumers upon request.

The new law will be a major benefit for consumers and will help lower health care costs, said Jane Cooper president and chief executive officer of Milwaukee-based Patient Care, an advocacy company that helps employee members navigate the health care system. With the new law, consumers will be able to make “apples to apples” comparisons between providers and will be able to make choices between them based on cost and quality, Cooper said.

“It’s a really good thing for consumers and ultimately for health care costs in Wisconsin,” Cooper said. “What it really means is that the end user has the ability to get a more precise understanding of what their health care services are going to cost. In the Milwaukee marketplace there are significant differences in cost and quality within the same network. The new law is designed to encourage competition among health care providers in cost and quality. Once consumers have the tools to make informed decisions we have a better chance at slowing the rate of increase in our health care costs.”

The new law goes into effect Jan.1, 2011. Many health care providers have already taken steps to become more transparent with cost information about their services.

“What this bill will do is actually put the information into the hands of the consumers,” said Eric Borgerding, executive vice president of the Wisconsin Hospital Association. “The association has already been collecting a lot of this data anyways. We just haven’t had a consumer that needed it. Even now we can’t force people to be educated consumers, but we can make sure they have the tools that they need to be educated consumers if they want to be.”

Under the new law, hospital systems must provide the median billed charge for the top 75 inpatient and the top 75 outpatient procedures. Other health care providers will be required to provide a list of charge information for the top 25 conditions they treat.

The Wisconsin Hospital Association will identify what needs to be on the list for hospitals and the state Department of Health Services will define the list for other health care providers. All providers and hospitals will be required to display a statement informing consumers of their right to receive that information.

“In terms of hospitals, implementation is going to be pretty smooth,” Borgerding said. “We will simply leverage and take advantage of the technology we already have in place.”

The Wisconsin Hospital Association already collects quality and pricing information from all member hospitals on a quarterly basis. A large portion of hospital cost and quality data is already published via the association’s Pricepoint and Checkpoint web pages ( and, Borgerding said.

“The fact is that someone should always be able to find out what the price of a service is,” Borgerding said. “As an association we have always strongly supported that.”

Hospitals in the area support the transparency initiatives as well.

“As a system, we have been involved with the Wisconsin Hospital Association’s Pricepoint and Checkpoint cost and quality initiatives from the beginning,” said Maureen McNally, director of government relations for Wauwatosa-based Froedtert and Community Health system. “That initiative is viewed as a national model and Wisconsin has truly been seen as a leader in health care transparency.”

According to McNally, Froedtert and Community Health has also given patients customized estimates when they request one and doesn’t see the new law as a monumental change from what the system is already doing.

Waukesha-based ProHealth Care also participates in the Wisconsin Hospital Association’s Pricepoint and Checkpoint data sites, but also started its own transparency initiatives via its consumer inquiry line back in 2004, said Nan Nelson, vice president of finance for ProHealth Care.

“Much of that information has migrated to our website, and we’ll have to expand our initiatives a little, but the new bill is very consistent with what we’ve already been providing as a system,” Nelson said.

Wheaton Franciscan Healthcare spokesperson Anne Ballentine said data submission on that system’s part will not change at all. Wheaton’s cost and quality information is already displayed in the Wisconsin Hospital Association’s Pricepoint and Checkpoint websites and the association may have to make changes to the way the information is displayed to meet the criteria of the new law, she said.

“We support transparency in pricing and quality information and see this law as a positive step in helping to inform health care consumers,” Ballentine said.

Mike Repka, executive director of the Independent Physicians Network in Wisconsin, said that independent physicians and medical providers have always supported cost transparency.

“I can’t speak for all of our members at this point, but independent physicians have historically believed in increased transparency,” Repka said. “Many believe they are more cost effective than larger hospital systems and so an increase in transparency should help them attract and retain customers.”

Insurance providers and health plans also have some new responsibility under the new law. Insurance companies will need to provide a good faith estimate of out-of-pocket costs to consumers based on a person’s benefits or individual coverage.

In 2008, the insurance provider members of the Wisconsin Association of Health Plans, pledged to provide out-of-pocket cost estimates to enrollees who requested them before receiving services, said Phil Dougherty, senior executive officer of the Wisconsin Association of Health Plans.

The members of the Wisconsin Association of Health Plans include Humana, Anthem Blue Cross Blue Shield, and United Health Care of Wisconsin.

“As an association we knew there was a need for this type of information and our member associations and affiliate groups pledged to provide that information to consumers,” Dougherty said. “Today, other health plans are doing even more than that, but we will continue to provide that type of innovation to our insured and it goes to show that it doesn’t necessarily take legislation to make productive changes in the market.”

Info: To check out existing cost and quality information for Wisconsin health care providers visit, and

Sign up for BizTimes Daily Alerts

Stay up-to-date on the people, companies and issues that impact business in Milwaukee and Southeast Wisconsin

No posts to display