Kill Your Chargemaster

Philip Betbeze, for HealthLeaders Media , May 10, 2013

In fact, many of you would argue that the chargemaster prices cited above, and throughout the CMS data release, are irrelevant given the actual reimbursement amount. OK. I'll buy that. Anyone who knows healthcare would buy that. But that doesn't mean the "list prices" are meaningless.

If the chargemaster prices are so irrelevant to your organization's reimbursement, why do they exist? I've never gotten a satisfactory answer to that question in nearly 13 years of covering healthcare.

The only reason must be that since commercial insurers also negotiate to get the best deal they can and often start negotiations with Medicare payments, that the list prices are intended for the uninsured.

Several stories in the trade media over the past 10 years have focused on the role the chargemaster plays in billing the uninsured for care. Court cases on hospitals' nonprofit status have been based at least tangentially on chargemaster billing, as have Congressional hearings and the beefing up of requirements for hospitals to justify their tax exemption through the IRS.

Time Magazine didn't discover the practice of billing the uninsured based on the chargemaster. But Steven Brill's article has received a lot of attention not only for its comprehensiveness, but also for its focus on real people who are paying "full boat."

So don't tell me chargemasters don't matter. They clearly do for some people.

In stories I've written about charity care policies, nonprofit status, the cost of the uninsured to hospitals, and so-called patient-friendly billing, hospital and health system senior leaders insist that chargemaster prices represent a data point for negotiations with private insurers.

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8 comments on "Kill Your Chargemaster"

phil (12/5/2014 at 10:25 AM)
Assuming there are convoluted arguments being passed around and along to help talk down accusations of plain ol outright gouging, I would expect points on the map of such apologisms to be colored most heavily upon the "greedy outlier"s. And then where is all that money winding up? All the way down to second tier administrator multi-millionaires, throughout the industry from hospitals to pharmas all the way to equipment makers??? The chargemaster, being inanimate software, can't be pocketing it, or buying mansions, yachts and sports cars with it, although I gather the phrase "don't ask me, ask the chargemaster" has been paraphrased a great many times when gumshoe reporters show up. Anyway, pattern recognition is a powerful tool once the will and authority is in place to bring that hammer down.

stefani daniels (5/23/2013 at 10:38 AM)
Mr. Poggio is right on target. The chargemaster is a legacy leftover from the old CBR days - which is true for many of the hospital 'business' activities. It relates closely to the hospital's continued use of LOS as the primary indicator for resource efficiency. In my HealthLeaders article, The Myth of Length of Stay, I contend that LOS is a holdover metric when it was the only measure that the hospital could easily access. Over the years its become a surrogate for efficient delivery of hospital services and physician practice behaviors. Similarly, the chargemaster is the legacy surrogate for accurately pricing hospital services.

Frank Poggio (5/13/2013 at 8:30 PM)
Here's the 'satisfactory answer you've been after... If there was ever a report that was self-indicting this is it. Yes hospital charges are non-sense, all over the map, not based on logic, etc. All true. But how'd that happen. As a former CFO I can tell you it was all done via the Medicare Cost Report, the core basis of Medicare payment system. For almost five decades the government has used the Cost Report, and a myriad of other convoluted reimbursement systems, to calculate payments to hospitals. So over the decades any good CFO would make sure that his charges maximized his governmental payments. And Medicare and Medicaid usually make up 60% or the his total payments. Some fifty thirty years ago charges became a substitute for statistics and cost accounting to estimate how much the government was going to pay you. Ever hear of RCCAC? That's the Ratio of Costs to Charges as Applied to Costs, a key calculation in the Cost Report. One of the most insane ways of 'identifying' costs ever cooked up. And it's still used today! Hospitals get paid based on DRGs, but still must do a Cost Report to justify the DRG amounts. I was around in 1983 when the feds came up with DRGs, they said back then the DRG system would replace the Cost report...and here we are 30 years later- with both! If you want to know why charges are a mess...just look at the Cost Report, and ask who created that monster?Oh, the government ...the same one that now complains about warped prices? What did they expect? Frank Poggio The Kelzon Group




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