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5500 Preparer's Manual for 2012 Plan Years
The premier resource in the field of Form 5500 preparation, 5500 Preparer's Manual will help you handle the required annual Form 5500 filings for both pension benefits and welfare benefit plans.
From Spencer's Benefits Reports: Although health care cost and quality “transparency,” or information, is highly desirable and necessary to foster health care consumerism, the system still is a long way from having credible tools, according to an August report from the Center for Studying Health System Change (HSC).
In A Health Plan Work in Progress: Hospital-Physician Price and Quality Transparency, Research Brief No. 7, the HSC researchers studied health care plans’ progress in providing information on hospital and physician cost and quality to consumers to help them make cost-effective provider choices. As plan sponsors push consumers to assume greater responsibility for health care treatment costs through higher deductibles, coinsurance, and other out-of-pocket dollars, cost and quality transparency has become another major competitive tool for health care plans.
The HSC found that health care plans were in “various stages” of making price information available to their members, but information on quality lagged behind or was virtually nonexistent, particularly for physicians. The price information that health care plans provide for inpatient and outpatient hospital services generally is based on the plans’ own negotiated rates or on third parties’ collection of claims data from multiple sources, such as the Medicare Hospital Compare program, the Leapfrog Group, and the American Hospital Association.
However, the HSC lamented the lack of information specific to individual providers and information available only for certain geographic areas. “Health plans’ ability to advance price and quality comparison tools to the point where a critical mass of consumers trust and use the information to choose physicians and hospitals will likely have considerable influence on the ultimate success of broader health consumerism efforts,” the HSC asserted.
Plans that primarily are HMOs do not provide price information to members because there is no demand given that members primarily pay fixed-dollar copayments. Of all the health care plans reviewed, only Humana reported Web site capability for price information for individual “customization.”
Plans that provide hospital price information generally provide average prices or a range of prices for the most common hospital services and procedures for certain geographic areas, the HSC found. Some national plans and one regional plan reported providing hospital-specific price information, although the prices are presented as the average total cost or range of costs for bundled services for the entire course of treatment or for common procedures such as knee surgery.
For physician services, few health care plans provide price information, and when they do, they provide the average cost of office visits in certain geographic areas. Some health care plans offer physician fee schedules or average prices for common office visits, and other plans offer efficiency “ratings” for physicians who meet specific criteria, the HSC reported.
Among the factors that currently limit the usefulness of price transparency, the HSC cites prevalent benefit structures that make members “insensitive to price differences across providers, including high-deductible health plans that limit out-of-pocket liability. Where plan members may feel the pinch of much higher costs is when they use out-of-network physicians,” the HSC noted.
Health care plans’ progress on quality transparency is more advanced than for price transparency, the HSC reported, because provider quality information is “valuable” to consumers regardless of specific benefit structures. However, health care plans “are proceeding cautiously in providing quality information because they fear pushback from providers if they attempt to place a ‘poor quality’ label on a doctor of hospital.” Then again, more “independent” quality data sources are available for hospitals than for physicians.
For hospitals, health care plans provide hospital-specific data on certain quality measures such as mortality, morbidity, average length of stay, volume, and complications. For physicians, performance information seems to be limited to physicians who are accredited by the National Committee on Quality Assurance (NCQA) for care of a limited number of targeted medical conditions such as diabetes. Plans also might rely on information on compliance with clinical guidelines obtained through the NCQA’s Healthcare Effectiveness Data Information Set (HEDIS). One major barrier to obtaining physician quality information is the lack of consensus on how to measure such quality, the HSC observed.
Most plans use a third-party provider of aggregated price and quality information, as well as health care decision tools. Frequently cited vendors of such information include Subimo, now a part of WebMD, and HealthGrades. Still, health care plans are wary of potential legal pitfalls, including if a patient was wrongly steered to a poor-quality provider with poor results. Plans also fear that members will misinterpret price and quality information by, for example, attributing high quality to high-price providers and shifting to those providers, or be unclear on how to apply the information.
For more information, visit http://www.hschange.com.
For more information on this and related topics, consult the CCH Pension Plan Guide, CCH Employee Benefits Management, and Spencer's Benefits Reports.
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