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Study: Private insurance pays hospitals 241% more than Medicare (186% in Kentucky); suggests shift to a Medicare model

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Study: Private insurance pays hospitals 241% more than Medicare (186% in Kentucky); suggests shift to a Medicare model Study: Private insurance pays hospitals 241% more than Medicare (186% in Kentucky); suggests shift to a Medicare model

Study: Private insurance pays hospitals 241% more than Medicare (186% in Kentucky); suggests shift to a Medicare model






By Melissa Patrick
Kentucky Health News

As health-care costs continue to rise for both employers and employees, one group of researchers says private insurers should move away from how they pay for hospital services, which requires them to pay a percentage of billed charges, and start paying the way Medicare does, based on a fixed-price agreements that are transparent to all. The American Hospital Association says that would not be sustainable, because Medicare doesn't pay hospitals enough.

The Rand Corp., a global research firm, made this recommendation based on its a study that found private health plans in the U.S. paid hospitals 241 percent more than what Medicare would have paid them in 2017, up from 236% in 2015.

Kentucky's private plans paid 186% more than Medicare in 2017, the fourth smallest difference among those in the 25 states surveyed. For inpatient treatment, the state's costs were second lowest of the 25, but its outpatient costs were above average.
All but five Kentucky hospitals in the study had a rate greater than 200% of what Medicare pays for outpatient services, with nearly 19 greater than 300% for that same measure. There was a bigger difference in prices for outpatient care than for inpatient care. In Kentucky those rates were 245% and 142%, respectively; nationally, they were 293% and 204%.

?The widely varying prices among hospitals suggests that employers have opportunities to redesign their health plans to better align hospital prices with the value of care provided,? Chapin White, the study's lead author and a policy researcher at Rand, said in a news release. ?Employers can exert pressure on their health plans and hospitals to shift from current pricing system to one that is based on a multiple of Medicare or another similar benchmark.?

The report says the data is also important because it allows employers to create networks that move their employees away from the higher-priced hospitals to the lower-priced ones.

The study reported on the relative price of private insurance to Medicare by dividing the amount allowed for private insurance by the amount allowed for Medicare for the same service, in the same facility. The researchers used data from about 4 million patients in 1,589 hospitals in 25 states.

The researchers used claims data from self-insured employers, two state all payer claims databases and records from health insurance plans that chose to participate. For each private claim, they re-priced the service using Medicare's grouping and pricing formulas.

Prices varied greatly by state and hospital. Of the 36 Kentucky hospitals in the study, private health-plan prices for outpatient services ranged from 85% of Medicare at Jane Todd Crawford Hospital in Greensburg to 526% at TJ Samson Community Hospital in Glasgow.

The study looked at three Kentucky hospital systems, including Baptist Health, Catholic Health Initiatives and Norton Healthcare. It found a decrease in relative pricing in each of the syst...
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Study: Private insurance pays hospitals 241% more than Medicare (186% in Kentucky); suggests shift to a Medicare model Study: Private insurance pays hospitals 241% more than Medicare (186% in Kentucky); suggests shift to a Medicare model

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News source: Kentucky Health News
Publication date: 10-06-2019 16:04
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