Private Insurers Pay Hospitals Wildly Different Rates, More Than Medicare
Typically, Rand researchers found, insurers paid 254% more than what Medicare pays for the same services, based on 2022 data. Separately, as at-home care rises, reports say hospital executives are telling patients to visit their facilities less often.
Private health insurance on average pays hospitals 2.5 times what Medicare does for the same services, with some states seeing relative prices of more than 3 times greater, according to a new RAND report. (Reed, 5/13)
Hospital-negotiated prices rose from 2020 to 2022, especially among dominant facilities in their respective markets, a new report shows. Commercial insurers' payments to hospitals amounted to, on average, 254% of Medicare rates in 2022, up from 243% in 2021 and 241% in 2020, according to data from Rand, a nonprofit research firm. Rand researchers used claims data from more than 4,000 hospitals in 49 states and Washington, D.C. (Kacik, 5/12)
More from hospital and health systems —
A cyberattack on the Ascension health system operating in 19 states across the U.S. forced some of its 140 hospitals to divert ambulances, caused patients to postpone medical tests and blocked online access to patient records. ... The attack had the hallmarks of a ransomware, and Ascension said it had called in Mandiant, the Google cybersecurity unit that is a leading responder to such attacks. (Hanna, Murphy and Foody, 5/11)
Hospitals want you to visit them less often. ... Hospital executives think they can more than make up the revenue by shifting their exam and recovery rooms to patients’ homes. And Congress is urging them on, with legislation in the works to help hospitals expand their at-home offerings and to allow Medicare to continue paying for telehealth after lawmakers first granted temporary permission after Covid struck. (Payne, 5/11)
For the decade-ish that I've been reporting on health care, insurance coverage has dominated conversations about who has access to care. But in the post-pandemic era, it's become clear that having insurance is only the first step toward receiving quality care. (Owens, 5/12)
From SouthPark to Steele Creek, Mountain Island Lake to Waxhaw, sleek and efficient freestanding emergency rooms are springing up across the Charlotte region to serve patients, no hospital required. Since 2010, Atrium Health has opened eight standalone emergency rooms in the Charlotte metro area, part of a nationwide building boom. (Crouch, 5/13)
In other industry news —
Harnessing the body’s own cells to fight disease, long a medical dream, is finally a reality. Now comes the bill. Last month, Stanford became the first hospital in the nation to use a new $515,000 cell therapy to treat a patient with advanced melanoma. A related approach, costing $420,000 to $475,000, is offering hope to patients with lethal blood cancers. (Krieger, 5/12)
The future of two operating and two shuttered hospitals in the Philadelphia region owned by Prospect Medical Holdings has been uncertain for months. Here’s an update on where things stand: More than three months after Prospect Medical Holdings started trying to sell Crozer Health under a timeline set by the Pennsylvania Attorney General, neither Crozer nor state officials will say whether any prospective buyers have emerged. (Brubaker, 5/13)
Obituaries —
Nancy Neveloff Dubler, a medical ethicist who pioneered using mediation at hospital bedsides to navigate the complex dynamics among headstrong doctors, anguished family members and patients in their last days, died on April 14 at her home on the Upper West Side of Manhattan. She was 82. The cause was heart and lung disease, her family said. (Rosenwald, 5/10)
