Health Care Thoughts: Cap per Procedure

by Tom aka Rusty Rustbelt

Health Care Thoughts: Cap per Procedure

Some employer health plans are experimenting with a cap-per-procedure system, allowing $X for a certain procedure and forcing employees to pay any difference.

This is not as harsh for employees as it first sounds, as the plans are using this as leverage to cap fees from providers, in effect pre-negotiating the fees within the employee cap. This is directed mostly at hospitals, which have wildly differing charge-masters.

This could be favorable for lower cost providers, and we were using this strategy for ambulatory surgery centers a decade ago (ASCs generally have lower prices and better patient satisfaction).

Experimentation is good, but this is gonna be a wild ride for the next few years.

HT: NYT 6/24/13

 

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