CMS is screwing down Medicare & Medicaid reimbursements to record lows taking revenue away from hospitals and providers. PPO contracts define discounts as simply percentages off hospital “charge-masters”. Nothing in PPO ASO agreements contractually defines “charge-masters” and especially nothing sets any limits. Possibly an average agreement implies a 60% discount. The hospital, losing revenue simply increases the aggregate charge-master and 60% then becomes bigger & bigger dollar amounts! This is how a box of Kleenex is paid by the plan at $150! If you can’t measure it, you can’t improve it. – Peter Drucker CMS Final rules for outpatient drugs https://www.linkedin.com/pulse/employer-health-plan-sponsors-need-independent-data-identify-dan-ross?trk=hb_ntf_MEGAPHONE_ARTICLE_POST


CMS is screwing down Medicare & Medicaid reimbursements to record lows taking revenue away from hospitals and providers. PPO contracts define discounts as simply percentages off hospital “charge-masters”. Nothing in PPO ASO agreements contractually defines “charge-masters” and especially nothing sets any limits. Possibly an average agreement implies a 60% discount. The hospital, losing revenue simply increases the aggregate charge-master and 60% then becomes bigger & bigger dollar amounts! This is how a box of Kleenex is paid by the plan at $150! If you can’t measure it, you can’t improve it. – Peter Drucker  CMS Final rules for outpatient drugs https://www.linkedin.com/pulse/employer-health-plan-sponsors-need-independent-data-identify-dan-ross?trk=hb_ntf_MEGAPHONE_ARTICLE_POST

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