The issue of what hospitals charge and how much doctors are paid, and what Medicare pays for, has import to the workers’ comp industry, as an article in Workers’ Comp Insider.com stated today, and in Modern Healthcare.com
According to Workers’ Comp Insider, the inpatient data released earlier this month by CMS, shows Medicare paid about $62 billion to cover more than 7 million discharges.
Bob Herman of Modern Healthcare said the following about hospital charges:
Hospitals have been under intense scrutiny for their billing practices, often triggered by extremely high charges—or sticker prices—for common procedures. Consumer groups and patient advocates argue hospital pricing is shrouded in secrecy, which has put patients on the hook for costly bills. But hospitals have said the listed charges are irrelevant because they only serve as a starting point for negotiations with insurers and that patients rarely, if ever, pay those prices.
Herman goes on to say that:
…Philadelphia, Los Angeles and Newark, N.J., had the largest gulfs in charges between the top and bottom hospitals. For example, in Philadelphia, the average difference in average hospital charges across all procedures was $123,847. In Los Angeles—an area rife with academic medical centers such as Cedars-Sinai Medical Center—the average difference between the highest-charging hospital and the lowest-charging hospital was about $112,000.
Physician data encompasses 950,000 physicians, nurse practitioners and other providers and $90 billion of Medicare funds, according to Herman, and spending on hospitals and physician services makes up a majority of U.S. healthcare expenses.
The Modern Healthcare article also listed the top ten Diagnostic Related Groups (DRG’s) by total payments to hospitals, and the number one DRG was DRG 470, Major Joint Replacement without major complications/comorbidities, with 446,148 discharges and $7 billion in payments.
So here’s the bottom-line:
If you think that you can negotiate your way out of paying through the nose, if you think that opt-out is going to be the savior to your bottom-line that its promoters promise it to be, and if you think that getting better medical care is possible in your local hospital, then by all means, continue to delude yourself, because that is what you are doing.
But if you see through all of the hype about opt-out, and see it for what it really is, an ideological tool that employers will wield against workers, and if you are tired of paying hospitals outrageous charges and paying for physicians to pad their bank accounts, then you need to consider an alternative to high-cost, average quality medical care, and consider medical travel.
It will save you money, and provide your employees with a better outcome and a better outlook on the job.
I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.
Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: firstname.lastname@example.org. Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp. Connect with me on LinkedIn and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.