November 12, 2021

Dear Colleagues,

A new study by the Hilltop Institute analyzed the insurance and cash pay prices for a colonoscopy (CPT 45380) and magnetic resonance imaging (MRI) of a lower limb joint (CPT 73721).  The study focused on three providers in the East, Midwest, and South:  Massachusetts General Hospital (MGH) in Boston, Massachusetts; the University of Michigan Health System (UMHS) in Ann Arbor, Michigan; and Vidant Medical Center (VMC) in Greenville, North Carolina.

According to the study, a patient in a high-deductible plan who has not met their deductible would save money by paying cash instead of going through insurance:

Why does this matter?


With increasing price transparency, consumers will elect to pay cash if they can save money.  In addition, as of 1/1/22, hospitals are required to provide a Good Faith Estimate to self-pay patients.  

HPS has developed the Case Rate Analyzer tool that enables hospitals to calculate how much it costs them to provide a packaged service, such as an inpatient DRG or outpatient surgery.  Upon knowing the cost of providing a service, a hospital can set a cash price to cover and include a reasonable profit margin.  Feel free to schedule a time to talk on my private calendar for a demo of Case Rate   


Rick Louie
Managing Director
Hospital Pricing Specialists LLC

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