Plain Talk 647: 'We are not collecting what we charge' (Video)
On previous episodes of Plain Talk, North Dakota Insurance Commisisoner Jon Godfread and Chris Jones, the former head of the state Department of Health and Human Services who is just wrapping up a stint as an adviser in President Donald Trump's administration, argued that health care pricing is opaque. They said that lack of transparency contributes to spiraling health care costs, and thus the rising cost of health insurance.
Godfread, specifically, pointed to research his office has done in North Dakota -- he's called it a "secret shopper" study -- showing wide disparities in pricing for routine procedures between the state's hospitals. In some cases, the price difference is as much as 600%.
For his part, Jones said that spiral prices for care, driving spiral prices for insurance, are bringing us "precipitously close to having a significant issue with access to health care."
What do the people who charge those prices have to say about it? Tim Blasl, the president of the North Dakota Hospital Association, said that while care providers do make prices available, that's usually not what those providers actually charge.
"Typically we don't collect those charges," he said on this episode of Plain Talk. "I would say 90 to 93% of our payments that we receive, whether it's from the federal government and CMS, or state Medicaid, or commercial, those have been sort of predetermined already. So even though we have a charge, we are not collecting what we charge."
"We do have to establish a charge," he continued, "but, again, if you have insurance in this country, you are not paying what that charge is. You're paying that negotiated rate that's been determined between the payer and the provider."
As for the secret shoppers? Blasl wondered if some of the differences could be the different ways hospitals calculate prices. A single procedure could require care from different groups within a hospital -- anesthesiology, radiation, etc. -- and when some hospitals provide a quote, they might be including prices for the entire bundle of care that procedure requires or just one part of it.
During the legislative session earlier this year, Rep. Jared Hendrix, a Republican from Fargo, introduced House Bill 1594, which would have implemented new state-level requirements for price transparency from hospitals.
Why did Blasl's organization oppose it? Because it was duplicative.
"The state wanted to make it a requirement, you know back in the last session, and we felt that was just another layer, because it mirrored what the federal government was doing," Blasl said.
"If you look at what that bill required hospitals to do, it's the same thing as what CMS requires us to do today," he continued.
"We just felt like it's a federal requirement now, why should we be spending state dollars to monitor it on the state level when the feds do it already?" he added.
If you want to participate in Plain Talk, just give us a call or text at 701-587-3141. It's super easy — leave your message, tell us your name and where you're from, and we might feature it on an upcoming episode. To subscribe to Plain Talk, search for the show wherever you get your podcasts or use one of the links below.
Apple Podcasts | Spotify | YouTube | Pocket Casts | Episode Archive