The Pratter team has heard all of the excuses as to why medical cost transparency is not possible. These excuses by some medical facilities are offered to protect their business profit model embedded in a veil of pricing secrecy. Our company’s website is living proof that not only is it possible but we have accomplished it. Pratter.us has the answers to make medical cost transparency a reality now!
First excuse: Medical cost transparency is too difficult to compare apples-to-apples because one medical institution’s heart failure and cancer patients are sicker than another medical institution’s patients with the same diagnoses. Therefore, pricing doesn’t reflect the sickness of the patient population.
Pratter.us response: 95% of medical care received in one’s lifetime is outpatient-based. This means that there are no hospitalizations. Outpatient medical care can and should be cost compared. A cholesterol level or MRI via the same medical equipment at different medical facilities should not have prices that vary across the country more than a new car – but they do. A simple outpatient procedure such as carpal tunnel surgery or a colonoscopy requires a fixed amount of time in similar medical settings and again can and should be cost compared. For the majority of America looking to stay healthy, seek preventable care and treat small medical problems early, becoming a health care consumer is vital a household’s financial stability.
Second excuse: Medical facilities are not allowed to publish their medical costs because their negotiated contract rates for payment of medical services by an insurance company has a confidentiality clause.
Pratter.us response: The first half of this statement is false. The second half is true. Insurance companies do make the medical facilities that they deal with for a health care provider network sign a confidentiality clause in regard to negotiated discount rates. Hospitals and surgery centers would have adverse financial and legal consequences thrust upon them if they published insurance company negotiated discount rates. However, hospitals, surgery centers, imaging centers and lab centers are permitted, encouraged and should provide their medical charges for all services for their communities. According to Pratter.us, the fair market price for a medical test is the average payment amount by the most common insurance carriers in the region.
Third excuse: It would take too long and too much effort to calculate and post medical prices online. In addition, we don’t have the medical cost and billing software expertise to do this.
Pratter.us response: Pratter.us is not asking medical providers to make public what they don’t already have in hand. All medical facilities and providers have a charge master, most often in an Excel spread sheet format. Each and every medical test has a unique five digit billing code that is standard in all 50 states.
Fourth excuse: Listing a medical cost for a procedure is not fair because it does not reflect the value of our service because we do it better and should be able to charge more than other medical facilities in our community.
Pratter.us response: Pratter.us is not meant to be all things to all people. Cost is a consideration in all other aspects of consumerism. Health care consumerism is here to stay as the cost burden has shifted to individuals bearing greater medical costs. If a person goes to buy a car, he or she is well aware of the good price for the desired vehicle via online searching. Quality assessment is based on other factors such as personal experience, word of mouth recommendation, review articles and consumer education by the car dealership. This process applies to all purchases and health care should be no exception.
Fifth excuse: Our hospital has to charge more because we have more overhead. Therefore, if we post our medical prices online, we would lose market share.
Pratter.us response: Reduce your overhead or lose market share. Medical facilities that refuse to post their prices have one thing to hide – high prices. We believe that the majority of medical care providers are about to tout their value based upon pricing and performance and we welcome all to our platform.