Becker's Hospital Review

Sign up for the COMPLIMENTARY Becker's Hospital Review CEO Report & CFO Report E-Weeklies at www.BeckersHospitalReview.com or call (800) 417-2035 For instance, one hospital's chargemaster, or price list, may state a significantly higher price for an MRI than the chargemaster at another facility. However, if the first hospital has a better contract with a patient's health insurer, that person could end up paying less out of pocket for the procedure than at the second hospital with the seemingly lower charge. law, says Don Dalton, vice president of public relations for the NCHA. Hospitals in the state are preparing to post pricing information and already have a history of transparency, he says. The NCHA has had a list of the prices for the top 25 DRGs at each hospital for years. Still, he says although the price of care will factor into people's choice of care providers, ultimately it won't be the only or even main data point they consider. Because of the intricate, interconnected relationship hospital prices have with Medicare costs, private payer contracts and other reimbursement factors, hospitals can't achieve transparency without help, Mr. Fifer says. "It's not like they can just wave a wand and change their prices overnight," he says. "It's going to take everybody in the industry to get to a rational pricing environment." Conclusion Overall, industry experts agree pricing transparency will only become more important for healthcare providers as patients begin to spend more of their own money on care, and hospitals will need to embrace a different competitive landscape without losing sight of the ultimate goal: providing high-quality care. Looking at the fees hospitals receive from private insurers especially can make it hard to compare, given complicating factors such as "carve outs" for particular services and the role of retrospective denials from insurers, says Mr. Pyenson of Milliman. "Those are complexities that may not appear in simple listings of prices," he says. Even if consumers do want to shop around based primarily on pricing, Mr. Meier says comparing the cost of treatment at different hospitals can be like "comparing apples and oranges" because of their different arrangements and contracts with health insurers. "Hospitals should lean toward transparency," Ms. Binder says. "It's one of the most difficult things to do, especially if you're unhappy with your performance in some area, but lean toward giving more information publicly, and you'll come out ahead in the end." n Just calling for hospitals to post their chargemasters doesn't really help consumers, says Mr. Fifer of HFMA. He describes the pricing system as "byzantine," saying the prices hospitals What are You Thankful For? Peace of mind You disinfected with DisCide Ultra! A RS *M P *aseeud *H 1N BV 1 ,H BC *H ru om gin on os as a *E . co li *S 's te le th eet *A f fl *In DisCide Ultra *V s V *HI avira n oro *C *S *H TAPH SV -2 203-377-6424 list sometimes don't really relate to what people actually pay out-of-pocket. "It's just overly simplistic," he says. "They don't really get to what's top-of-mind for the consumer." The out-of-pocket amount — not the amount listed on the chargemaster or the price for payers — is what matters most for patients, Mr. Meier says. "Getting to the individualized benefits is actually the best way to go," he says. "That's what we felt the patient wanted to know — not that the charge was going to be $2,500, but that the out-of-pocket was going to be $500." "While we may be moving into an area where people are more interested in pricing and what their insurance pays and what they would be expected to pay, historically people have selected their hospital based on where their physician practice is or based on where their insurance company has a networking agreement," he says. "No single point of data is probably sufficient for an individual to make a judgment on." al m on ell a a-A nz ue kills over 21 microorganisms* 9 in 1 minute or less! RE *RS *H3 V N2 One and only 1 Step in 1 Minute or Less!!! The staff at Palmero's wants to wish you a Healthy Happy Holiday! www.palmerohealth.com

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