How Much Are You Charging?

Author: Jordan Johnson

A recent study published in Health Affairs,  discusses the narrowing gap between public and private hospital payment rates. The study indicated that the rates hospitals charge for care, including inpatient, outpatient and emergency services, have skyrocketed. The analysis found dramatic growth in hospital charges, which rose from three to five times Medicare payment rates by 2016. The same study also found that the gap between what private and government insurers pay hospitals widened between 2000 and 2012. However, that gap narrowed between 2012 and 2016. Thomas Selden, PhD, a director of research at the Agency for Healthcare Research and Quality, did an excellent job on this study.

Legislation such as the requirement to publish the private negotiated rates of payors will create a greater level of accountability as well as drive patient consumerism to the next level. Oncology is a high spend service line and patients will demand to know the cost of treatments and their oncology care path.

Legion Healthcare Partners is taking a proactive approach specifically for oncology. Our ClaimHealth^® program will audit all claims data and provide analytics and operational actionable items. This data can then be used to populate the Legion Financial Suite, which creates specific estimators and budgetary tools based on your case and payor mix. The datapoints that are needed for this development are many, but once organized and validated the most innovative and useful tools have been created for oncology. There has to be direct correlation between what is charged, paid, and the outcome. The solution is in your data and will be required as legislation passes.