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
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