Question for Hospital Administrators

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It is no secret in our industry what plan sponsors pay towards patient advocacy, balance billing defense and legal defense. I am positive you know too.

Question for Hospital Administrators

By Bill Rusteberg

How do hospitals compete with other hospitals which turn cost-sharing health plans into 100% health plans? (See link to blog entry below). Do they adopt the same strategy?

Will the hospital bill collection business then become obsolete? Since it hasn’t yet, I suspect most hospitals continue to play by the rules while renegade hospitals rake in the dough at their expense.

Seems to me one way to compete with rogue hospitals, especially in view of the growing phenomenon of Reference Based Pricing strategies by plan sponsors, is to reach out directly to local plan sponsors for direct contracts that are fair and transparent with strong steerage.

Reference based strategies are gaining market share fast. What hospitals don’t seem to understand is Reference Based Pricing is not going away.

The problem as I see it is some (not all) plan sponsors are paying an arm and a leg for patient advocacy, balance billing defense and legal defense. Reference Based Pricing Plans pay anywhere from 120% of Medicare to 150% of Medicare, depending upon the risk tolerance of the group. On top of that must be added the sometimes enormous cost of patient advocacy, balance billing defense and legal defense.

Rather that paying for these services to third party intermediaries, doesn’t it make more sense to pay this plan expense directly to providers instead in the form of higher reimbursement rates?

It is no secret in our industry what plan sponsors pay towards patient advocacy, balance billing defense and legal defense. I am positive you know too.

So, please explain to me why it doesn’t make sense to direct contract on terms that (1) you will earn more than you do now on reference based pricing patients you already see and cash checks for, and (2) receive steerage on steroids that is lacking in today’s world of APO’s (all provider organizations better known as PPO’s).

Oh, I forgot, you will actually earn less than the 200% – 300% and more of Medicare you are averaging these days. So I am guessing your are thinking “Why should I agree to earn less than I am earning now!”

I suppose my answer would be “If your not the first to do this, then some day in the future you will be, at best, the second to do so.”

Hospital Knows How To Play The System – Turning Cost Sharing Plans Into 100% Plans

Hospital system knows how to turn cost sharing health plans into 100% plans, much to the delight of plan members…………….

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