HF 2224 (LSB 5243YH (5) 83)

HOUSE FILE 2224

BY  UPMEYER, WATTS, TYMESON, SWEENEY, RAYHONS, HEATON, WORTHAN, HUSEMAN, KAUFMANN, and CHAMBERS

A BILL FOR

An Act relating to health care cost and quality transparency.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  135.167  Health care cost and quality transparency —— development of information portal.
   1.  As used in this section, unless the context otherwise requires:
   a.  “Health care provider” means a person who is licensed, certified, or otherwise authorized or permitted by the laws of this state to administer health care in the ordinary course of business or in the practice of a profession.
   b.  “Hospital” means a hospital as defined in section 135B.1.
   c.  “Performance measure” means a quantitative tool that provides an indication of an organization’s performance in relation to a specified health care process or outcome.
   d.  “Performance outcomes” means information about the results of health care based on performance measures.
   e.  “Quality of care” means the result or outcome of health care efforts.
   f.  “Reporting program” means an objective health care feedback mechanism regarding individual or facility performance that can be used internally to support performance improvement activities and externally to demonstrate accountability to the public and other purchasers, payers, and stakeholders.
   2.  a.  The department shall develop a public access health care cost and quality information portal. The information portal shall provide information reported by hospitals and health care providers on quality of care and the costs of receiving care. The information portal shall be phased in over a multiyear period, beginning with information collected from hospitals and subsequently including other health care providers. The department shall work with existing hospital and health care provider data collection entities in developing and implementing the information portal.
   b.  The department shall develop an internet site, in cooperation with the electronic health information advisory council and its executive committee created in section 135.156, to support the public access health care cost and quality information portal in a manner that allows consumers to perform a comparative analysis of the cost and quality of health care provided in the state. In making the health care information available on the internet site, the department shall:
   (1)  Organize the an internet site in a manner that facilitates ease of use by consumers.
   (2)  Exclude from the internet site any information that compromises patient privacy.
   (3)  Include links to internet sites of hospitals and other health care providers to enable consumers to obtain additional information about hospitals and health care providers, including programs designed to enhance quality and safety, and reduce costs.
   (4)  Allow the linkage of other internet sites, at the discretion of the department, to the internet site for the purposes of maximizing information sharing.
   (5)  To the extent possible, include state and federal benchmarks for performance measures.
   (6)  Clearly identify the sources of data used in the internet site and explain the methodology used to develop the performance measures.
   3.  The department shall determine which medical conditions and procedures, performance measures and performance outcomes, and cost and charge data to include on the internet site.
   a.  In determining which medical conditions and procedures to include, the department shall consider such factors as volume, severity of the illness, urgency of admission, individual and societal costs, whether the condition is acute or chronic, variation in costs, variation in outcomes, and magnitude of variations and other relevant information.
   b.  (1)  In determining which performance measures and performance outcomes to include, the department shall consider such factors as volume of cases, average patient charges, average length of stay, complication rates, mortality rates, and infection rates, among others, which shall be risk-adjusted and severity-adjusted, if applicable.
   (2)  Performance outcome indicators shall be risk-adjusted or severity-adjusted, as applicable, using nationally recognized risk adjustment methodologies, consistent with national standards, as selected by the department.
   (3)  The performance measures shall be based on medical evidence and shall be developed through a process in which hospitals and health care providers participate.
   (4)  The department may also consider such additional measures adopted by the federal centers for Medicare and Medicaid services, the national quality forum, the joint commission on accreditation of healthcare organizations, the federal agency for healthcare research and quality, or a similar national entity that establishes standards to measure the performance of hospitals and health care providers, or such additional measures adopted by other states.
   c.  In determining which cost and charge data to include, the department shall consider such measures as average charge, average net revenue per adjusted patient day, average cost per adjusted patient day, and average cost per admission. The department shall also utilize its authority and the data collected pursuant to sections 135.74 through 135.79 in providing cost and charge data.
   d.  The department shall have the right to review any and all documentation upon which submitted data are based, upon reasonable notice and in accordance with department rules.
   4.  a.  The department shall develop a reporting program and uniform reporting form for distribution to hospitals and health care providers to report the medical conditions and procedures, performance measures and performance outcomes, and cost and charge data selected for inclusion on the internet site.
   b.  The department shall require each hospital to make available an electronic copy of the hospital’s charge description master for the department to post on its internet site. For the purposes of this paragraph, “charge description master” means a uniform schedule of charges represented by the hospital as its gross billed charge for a given service or item, regardless of payer type.
EXPLANATION
   This bill relates to health care transparency. The bill directs the department of public health (DPH) to develop a public access health care cost and quality information portal to provide information reported by hospitals and health care providers on quality of care and the costs of receiving care. The portal is to be phased in over a multiyear period, beginning with information collected from hospitals and subsequently including other health care providers. The department is required to work with existing hospital and health care provider data collection entities in developing and implementing the information portal.
   The bill directs DPH to develop an internet site, in cooperation with the electronic health information advisory council and executive committee, to support the public access health care cost and quality information portal in a manner that allows consumers to perform a comparative analysis of the cost and quality of health care provided in the state. The internet site is required to include medical conditions and procedures, performance measures and outcomes, and cost and charge data, and the bill specifies the considerations DPH is to review in determining the medical conditions and procedures, performance measures and outcomes, and cost and charge data to include. The bill also directs DPH to develop a reporting program and uniform reporting form for distribution to hospitals and health care providers to report the medical conditions and procedures, performance measures and outcomes, and cost and charge data selected for inclusion on the internet site. Additionally, DPH is to require each hospital to make available an electronic copy of the hospital’s charge description master for the department to post on its internet site.