Hospital prices have come under seemingly ever increasing scrutiny recently in various forms.  The TIME magazine article by Steven Brill, “The Bitter Pill,” which was a comprehensive outsider’s analysis of The Charge Description Master (CDM), has certainly generated some interesting discussions at not only social events, but also in most C-suites and hospital board meetings.

Almost simultaneously, the Medicare program’s recent release of hospital charge data has generated significant national media attention to this issue.  The dialogue regarding the growing influence of consumer-driven utilization of health care services and pricing transparency has taken on a life of its own as we enter this new era of healthcare delivery.

Everyone familiar with the inner workings of the health care industry knows that the CDM’s patient prices represent a very complicated issue.  And while a few healthcare consulting firms have been on the leading edge regarding this matter, fewer still have taken the steps to recommend that hospitals and health systems implement the wide range of policies and procedures needed to begin to appropriately address it.   These steps can include initiating suitable charity policies and installing processes that allow you to estimate patient liability , but even these do not produce a solution that will help to ameliorate the challenges raised by this new national transparency.

One crucial task that a hospital should perform is the development and implementation of a thoughtfully considered and carefully structured CDM patient pricing methodology, but delivering that solution has been consistently elusive.   

One firm however, SunStone Consulting, LLC, has incorporated its years of experience into the development of Pretium, a new web-based CDM pricing solution.

In their work as financial consultants to over 250 hospitals and health systems in the United States over the past 30 years, SunStone’s consultants have performed literally hundreds of pricing analyses and rate setting engagements. These engagements have been for hospitals ranging in size from 35 to 1,250 beds and including academic medical centers, major teaching hospitals, for and not-for-profit health systems, community and small rural hospitals.

Developed with SunStone’s expertise, and based on each user hospital’s customized structured charging methodology, Pretium offers a high degree of confidence in CDM pricing.   Other pricing software tools most frequently provide the user with plenty of information, but ultimately leave the identification of the actual CDM price to someone’s judgment.  This is not so with Pretium which calculates a CDM price and provides comprehensive documentation relating to exactly how each and every price was determined.

As most professionals in the healthcare finance business know, CDMs contain complex algorithms with large amounts of internal relational logic.  Pretium allows a user to incorporate all of these unique pricing considerations present in many patient services with individualized, specific, detailed pricing issues.

Pretium also provides a state-of-the-art Pricing Review screen that equips the user with powerful analytics that ensures that calculated proposed prices make sense in the context of the hospital’s pricing philosophy. This Pricing Review screen permits the user to quickly and easily make pricing changes and to determine immediately the estimated impact on gross and net patient revenue.  This feature then makes it possible to identify CDM prices that will protect the hospital’s net revenue stream while being sensitive to the local market, individual hospital’s cost and other internal and external benchmarks.

Finally, Pretium facilitates the user’s ability to explain detailed patient prices while keeping the organization in compliance with specific pricing regulations and guidelines.  These features, combined with SunStone’s expert pricing consultants’ advice, provide a powerful tool that can be used to accurately recommend pricing for the entire CDM.

Pretium is profoundly different from typical software pricing tools, and with the availability of continuous software upgrades in this heavily scrutinized environment, this CDM program can make these complex decisions and changes more accurate and dependable on an ongoing basis.

For more information or to schedule a demonstration, please contact Leonard Brauner at 212-622-9393 or via email at leonardbrauner@sunstoneconsulting.com

I recently saw a rather robust list of apps that apply to your health.  If you don’t know what apps are, you might want to consider reading a different blog, but if, like me, you’re old but still curious, you’ll keep on reading.  So, these apps can be used on I phones, Androids, and tablets.  Some of them are relatively incredible, some aren’t; and some are just fun, but, no matter, they are the future.  App Health.  

The first app is called Brush DJ.  One of the less impressive genes that my grandkids seem to have inherited from me is teeth related.  You see, my teeth were always referred to by my mom as “soft teeth.”   As a kid, growing up without fluoride and having an aunt with a penny candy counter in her store, I just thought soft meant rotten teeth.  Cavities happened a lot to me.  Don’t get me wrong, I brushed ‘em, but, probably not often enough.  Then, after the dentist would fill my teeth with all of that wonderful mercury, he’d give me a lollipop.   

So Brush DJ goes into your telephone or tablet’s music collection, randomly selects a song and plays it for two full minutes while showing you where you should be brushing and at what time.  Cool, huh? 

I have mixed feeling about this one.  It’s called Depression Screening.  This app helps to identify depression issues; it assesses and tracks feelings of possible depression.  I haven’t tried it yet because it seems somewhat depressing.  ( Okay, I know, not PC.)   

Gene screen is described as a fun way to learn how recessive genetic traits and diseases are inherited and how certain diseases are more prevalent in different populations.  It also provides information on some recessive genetic diseases and screening programs.   

Let me be fully transparent here because, once again, I haven’t tried this one.  I don’t think that I  really want to know why my mid-section is now about a foot and a half shorter than my overall height or maybe, just maybe, I don’t care which one of my grandfathers or potentially grandmothers contributed to my excessive bodily hair which is everywhere but on my head.   

The next one is called, I prevent running injuries. It’s supposed to protect you from injuries.  I wasn’t even going to download it because the last time that I ran was to the dinner table. On the other hand, I have had friends who, while running and not paying attention to their surroundings, ran into street signs and had to have stitches.  Oh, and another friend fell into a sewer, but was very lucky and swam to safety.   

So, if you’re a runner or a swimmer you might consider that app.   

Finally, the Nottingham Hip Fracture Score Calculator wins it all.  This nifty little app will predict mortality in patients over 65 with a fractured neck or femur, and the app allows for rapid calculation of the score.  

Even though all of my old relatives are dead, I may just download this one for the fun of it.  So, Aunt Amy fell out of the tub?  Should I bother to cover her with a sheet and call the ambulance, or . . . what the heck?   This sounds like an app that was either created by a cold hearted actuarial, a surgeon who is calculating the maximum surgical time or possibly, an ambulance chasing attorney?   

First of all, why do you need to calculate this situation so quickly?  Is it part of the Death Panels of the Affordable Care Act?  (For you NSA guys with those little bomb filled drones, that was a joke.)  

Finally, this is America!  We are entitled to spend as much as we want on healthcare; no matter how stupid the outcome.

I’ve spent the last year dealing with changes, some good, some okay, some not so good and some that are simply amazing.  I learned a long time ago that regardless of our desires, rivers keep flowing, trees keep growing, and life goes on around us.  Interestingly enough, however, lots of people don’t seem to see things that way.  It feels like about 40 percent of us want time to stop and are longing for a make-believe era when things were utopian.  (I was alive then.  It wasn’t all that great.)

Kahlil Gibran, the Lebanese-American writer and poet who is the third best selling all time poet behind Shakespeare and Lao-Tzu, once wrote, “Perplexity is the beginning of knowledge. ”  To say that I’ve been perplexed by some of the changes that we’re facing would be a colossal understatement, but I do remain completely curious.  It seems to me that if we cease to be curious, stop seeking knowledge, or think that we know it all and don’t care if we learn anymore, that’s when we get into trouble.  That’s when we dig in to defend beliefs that have been completely debunked,  have always been  false, or are just downright stupid.

My grandfather, for example, refused to wear pants with zippers.  He’d say, “Those new fangled things are ridiculous.”  More importantly, however, I think he might have been afraid of them because, not unlike the scene from “Something About Mary,” things can occasionally get caught if you’re not paying attention.  So, it appears that a lot of people are just downright afraid of change.

Believe me, Pasquale wasn’t a stupid guy.  He loved fun, people and life, but when changes bothered him, he’d dig in and be so stubborn that it was almost incomprehensible.  Let’s put this into even more perspective.  He left home at age 13, made his way to the port of Naples on foot from the middle of Italy, got on a boat and came to America . . . alone.  Then, he found a job, went back years later and found a wife. He raised his family here while learning to speak English and play the stock market.  No change involved in that story, huh?

When I try to explain the coping mechanisms needed to embrace change, I usually fall back to a quote from Morgan Freeman who said, “I always tell my kids if you lay down, people will step over you. But if you keep scrambling, if you keep going, someone will always, always give you a hand. Always. But you gotta keep dancing; you gotta keep your feet moving.” 

That quote grabs me because dancing is a good description of coping.  Think about it.   When you are dancing, say, at a holiday party or a wedding, you’re typically not in control of the music selections, the order in which they are played or even the style of music that you’ll be dancing to during any given set of tunes.  It’s like life.  Things keep coming at you that you can’t control.

Dancing is creative exercise, a way to move around the floor, and, most importantly, a way to have fun.  In the late 60s, Sly and the Family Stone (It was Freddie, Rose and Sly Stone; hence the name.) performed a song called “Dance to the Music.”  At the beginning of the song, one of the musicians screams to the audience demanding that they, “Get on up…and dance to the music!”

Well, that’s what we’ve been doing, and that’s what the heck you need to do, too.  Get up and dance to the music.  Turn it into entertainment, enjoy the changes, and see just  how flexible you can be because unless or until the plug is pulled or the battery runs down, change is gonna be with you, and it only stops being fun when you stop trying to dance.