Careignition reposted this
The Top 5 ways prices still stay hidden in healthcare: 1. Secrecy - Until recently network rates were closely held trade secrets. Even now, lack of clarity in price transparency files, coupled with restrictive access to commercial claims data still keep us in the dark. 2. Discounts - Folks have historically used discounts to compare network prices. Discounts are not prices. A 5% discount at Whole Foods is a lot more than full price to Aldi. A provider with a 50% discount can have lower prices than a provider with a 70% discount. 3. Percent of Medicare - "100% of Medicare" is not a number, it's an algorithm. At one hospital, the algorithm may reimburse $19,000 for an Inpatient Joint Replacement, while down the street another hospital gets paid $14,000 for the same service. Between sites of service, "100% of Medicare" varies as well (as much as 50%). Within the same health system, for the same MRI, a standalone imaging center gets paid $300, while a hospital gets $500. 4. Unit Definition - The same clinical service can be billed differently depending on provider, contract, and place of service. An MRI with contrast can be billed 200+ different ways and still mean the same thing. Variations can include claim types, revenue codes, modifiers, number of bills, procedure codes used, and more. 5. Utilization - Providers and patients choose different inputs to treat the same condition. Some colonoscopies include anesthesia, others do not. Some folks are more aggressive with using surgeries to treat a disease, others use drugs or physical therapy. At Careignition, we are dedicated to breaking through the obfuscation and providing our customers -- benefits and healthcare consultants, employers, hospital systems, and analytics companies -- true visibility into healthcare prices.