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We had a call with someone who works on the pricelist/chargemaster for a major metro hospital recently, they set their prices by taking the Medicare reimburseme
by ericd 7y ago
We had a call with someone who works on the pricelist/chargemaster for a major metro hospital recently, they set their prices by taking the Medicare reimbursement rate, and multiplying by 8.
- Gibbon1 7y agoIf any other business tried billing people like hospitals and doctors do, people would go to prison.
- pkulak 7y agoAt least if it was an inelastic good like health care. Gas goes up a quarter and elected officials are thrown out of office. $600 for a drop of super glue? Okay then.
- AaronFriel 7y agoThat $600 is just monopoly money to the majority of constituents, because they have insurance of some kind or they're on Medicare/Medicaid. So those people are usually, not always, but usually fine. And that of course is part of the problem. Medical billing is like playing numberwang or who's line is it anyway. No two numbers on a bill seem to be correlated in any way to another except as upper or lower bounds. When someone without coverage comes in then, they have to play that stupid game with all the numbers, and of course they either ignore it and go into debt, pay the cash price if they're able, or they manage to negotiate it down by orders of magnitude - proving the price didn't matter anyway.
- deleted 7y ago[deleted]
- Ididntdothis 7y agoThat’s what i don’t get. A lot of the billing is clearly fraudulent. They routinely bill for treatments that never happened or for drugs that were never given.
- teej 7y agoHospitals that take a majority Medicare patients go out of business. Medicare patients are subsidized by the rest of a hospital’s patient population.
- Retric 7y agoThat’s a common but false talking point. Hospitals with above average Medicare patients generally get paid more than the general population. It’s also a question of what percentage of a nominal bill gets paid vs sent to collections.
- AnimalMuppet 7y agoGiven that it's a common misconception, would you supply some evidence for your position?
- Retric 7y agoHospitals receive extra payments when they have an unusual number of Medicare patients. https://www.medicaid.gov/medicaid/finance/dsh/index.html https://www.medicaid.gov/medicaid/finance/dsh/index.html It’s just another case where the government splits spending across multiple programs.
- AnimalMuppet 7y agoI didn't know that program existed. Still, I don't see that the existence of the program adds up to your assertion: > Hospitals with above average Medicare patients generally get paid more than the general population.
- mattmcknight 7y agoThat's Medicaid, not Medicare
- refurb 7y agoWhen they have a disproportionate share of Medicaid, not Medicare patients. And the added payment isn’t that much. Generally Medicaid pays below cost. Medicare is reasonable and leaves providers with a small profit (single digit percentage).
- mattmcknight 7y agoSimple change to next year's Medicare plans: if you accept Medicare you cannot charge any patient more than you charge Medicare.
- noelsusman 7y agoSimple way to put most hospitals out of business overnight. Or, more likely, simple way to force hospitals to make drastic cuts to services.
- mattmcknight 7y agoOr Medicare prices rise to be closer to real costs, instead of forcing them to be subsidized by the uninsured.
- hollerith 7y agoThat was tried during the Clinton administration. Result: many doctors dropped all their Medicare patients, making it impractical for Medicare patients to find a doctor to treat certain conditions.
- mattmcknight 7y agoThen Medicare needs to pay a little more for those specialists.
- noelsusman 7y agoThis is pretty common. Uninsured patients are such a small percentage of revenue (and many aren't going to pay anyway) that hospitals don't put much effort into setting prices. Negotiating with insurers and navigating billing them is a big operation as it is.
- ericd 7y agoYeah, and there’s the Lesser Of clause in their insurance contracts - they’ll be reimbursed at the lesser of their retail rate and their negotiated rate. So they make their retail rate ridiculously high to make sure it’s never the limiter for insurance payments.
- PorterDuff 7y ago" they set their prices by taking the Medicare reimbursement rate, and multiplying by 8." lol. Seriously? Well it's a simple system. I wonder what happens when it's Medicare-for-all. Do they make 1/8 as much all of a sudden?