Insights into hospital pricing
By Charity Beall, CHM Chief Financial Officer (CFO)
Editor’s note: To read the first article in this new monthly series, please see the July 2019 issue of Heartfelt Magazine.
Last month’s “Dollars and sense” article centered on medical cost stewardship. I mentioned that in 2018 CHM satisfied more than $804 million in healthcare costs, representing 267,408 individual medical bills. A question I asked in the article was “What if we could have satisfied 300,000 medical bills for the same dollar amount?”
The answer is best illustrated by an example. Much like car buying, medical bill pricing is not standardized. You can go to three different auto dealers and be given three different prices for the same car, with the same color and options.
Similarly, every healthcare provider has the freedom to price their medical services independently. Neither the government nor any other regulatory body dictates how much a medical procedure should cost. Instead, procedures are priced by a number of different factors that a hospital rolls up into its “chargemaster.”
Factors affecting the chargemaster include:
- the hospital’s cost of procedure
- services needed
- prescription drugs
- diagnostic testing
- service fees such as equipment fees and room charges.
Most of the factors are variable and depend on what the provider determines is their cost to do business or provide a service.
It’s commonly known in the healthcare industry that hospitals deliberately create large “cushions” in their chargemasters to create price negotiating room with insurance companies. These cushions can be as large as 20 times the hospital’s cost for anesthesia and imaging (CT and MRI scans) and over four times the cost for other services.
Providers often can’t or won’t give you an estimate for what you’ll be charged to receive a service because of the large list of variables in the chargemaster.
In the car analogy, would you purchase a vehicle from one of the three dealers if you didn’t know what it was going to cost you? Of course not.
Though there are many wonderful advantages of being a CHM member, there are also challenges that can come as a self-pay patient. I ask you to embrace the challenge of price disparity with me so we can work together to find and create solutions. This cooperation is key to being good stewards of ministry funds entrusted to us by God.
You may wonder how we can overcome this challenge if all healthcare providers charge a different price. What should you do? Price shop. Price shopping is not as difficult as it first may seem. Follow these steps:
- Use a price shopping tool such as:
- Do an internet search of providers in your area and call to request pricing.
- Consider how far you’re willing to travel.
- Consider an Ambulatory Surgery Center (ASC) vs. a hospital.
- Engage your doctor.
- Ask them at which facilities they have privileges and if they work with an ASC vs. a hospital.
- Engage them in a pricing discussion. Your doctor is the professional most concerned with your care and understands fair costs.
In next month’s blog entry you’ll learn about how some providers are able to price their services fairly and transparently while offering quality care.
Thank you for taking this journey with me, learning with me and stewarding Kingdom dollars well.