A Roanoke Valley group pledging to offer solutions to improve health care has called for several new Virginia laws that would increase government oversight of medical practices and the insurance industry.

The Citizens Coalition for Responsible Healthcare Inc. has proposed seven ideas that its leaders say would protect patient rights and improve care by requiring health care providers to disclose more information.

Coalition leaders, however, admit all the proposals are in the early stages and some may not be viable. They have not had serious discussions with local legislators about support for new legislation.

"This is the first of a series of proposals. It's a start," said Ken King, president of the coalition. "We're trying to come up with some proposal that can be implemented and at least put them in the public sector to get considered and get the conversation started."

The newly organized coalition formed over criticisms of Carilion Clinic's business plan, but has now expanded its focus to that of an advocacy group for health care reform. Still, many of the proposals are aimed at addressing aspects of Carilion's operations that the coalition has questioned.

Specifically, the coalition maintains that Carilion has driven up the cost of health care by charging above the average price for certain procedures. Carilion officials have repeatedly called the allegation untrue and said on average hospital-based services cost more than independent, free-standing services.

To address the concern, however, the coalition has asked health care providers to make their lists of charges public and maintain an updated version at the public library. King said the idea is analogous to a restaurant menu where a consumer knows how much something costs before ordering and can compare prices.

Although this is one area where the coalition has not directly called for a change in Virginia law, transparency of health care cost disclosures has emerged as a hot topic in several other states.

"In general terms there clearly are precedents for states passing laws requiring some aspect of disclosure of pricing and cost for services," said Richard Cauchi, the health program director at the National Conference of State Legislatures. "There is sort of a range of specificity. Some require a report to the state, and some are making the information directly available to consumers."

It's an area Del. William Fralin, R-Roanoke, and state Sen. John Edwards, D-Roanoke, both said they are studying for possible future legislation.

Earlier this year, Edwards sponsored a bill that became law in March that scratched the surface by requiring the average cost of certain procedures be disclosed to the state.

"That's the beginning," he said. "My bill is really the first step to providing transparency in pricing. But it's still hard to compare."

Edwards said the bill didn't go as far as allowing patients to shop prices for certain procedures, but that it did provide a good building block for future legislation and disclosure.

A law the coalition would like to see adopted is one that would mandate a right to a second opinion for diagnoses and medical treatment plans.

"We think it's essential and that a true second opinion ought to given and sought," King said. "We think it really serves the consumer."

A state law specifying a right to a second opinion is something that has been implemented in nine states, including Maryland, West Virginia, New York and California, said Cauchi, noting that the laws were mostly adopted as a response to concerns over managed care.

"It was part of the consumer push back and patient protection movement that was very active in the mid-1990s and continued in some ways into this decade," he said.

Again, both Fralin and Edwards said they would be open to learning more about the idea.

"I think second opinions should be clearly available to people who want to get them," Fralin said. "If there is anything that prevents that, I think we should know why and that it should be looked at."

Another coalition idea that would require state and federal action was inspired by an existing proposal that has made its way around health policy circles. But the coalition's version doesn't quite reflect the intentions of the proposal's origins.

The coalition has asked for the creation of a federal agency with oversight and investigative powers related to health care injury and death, similar to how the Federal Aviation Administration governs the airline industry. The terms, as proposed by the coalition, would include a no-fault requirement for health care providers to report all errors and treat financial compensation for errors similar to the Workers Compensation system.

This idea originates with Dr. Denis Cortese, president and chief executive officer of the Mayo Clinic.

Cortese has said the health care arena should be able to learn from its mistakes and share knowledge similar to the airline industry, said Jane Jacobs, a spokeswoman for Mayo Clinic Health Policy Center.

Cortese has said a federal health board should be formed so medical errors can be recorded, studied and addressed efficiently without fear of punishment. However, Cortese has not suggested that malpractice cases should be handled similar to workers compensation cases, Jacobs said.

King said 15 more possible proposals are already on his desk for the coalition board to consider and he expects more to come. He said it was too soon to start prioritizing the various suggestions and determining which ones the group should concentrate on getting approved.

"We want to seriously dig our feet in and come up with real proposals," King said. "Some will be discarded as unworkable. We don't expect any of this to happen overnight, but you've got to start some place."

The coalition emerged out of a similar effort formed by a group of physicians in 2006 to vocalize concerns about Carilion's transformation from a traditional hospital to a clinic. That group, called the Coalition for Responsible Healthcare, has taken a backseat to the new coalition, with some of the physicians now taking leadership roles in the new citizens coalition.

The citizens coalition incorporated in September and has plans to file for nonprofit tax-exempt status.

On the Net: www.responsiblehealthcare.org