For over a decade, Parkview Health, a prominent hospital system in northeastern Indiana and northwestern Ohio, has been making headlines, but not for reasons that usually warm the hearts of patients or employers. As journalists revealed,Parkview Health consistently demands some of the highest healthcare prices in the nation,leaving many wondering how such a situation unfolded.
“Over more than a decade, Parkview Health has demanded that the people of north-eastern Indiana and north-western Ohio pay some of the highest prices of any hospital system in the country,” the investigative reporters stated, shedding light on the pervasive issue of exorbitant healthcare costs.
The Data Maze: Navigating the Challenges of Healthcare Pricing Clarity
Unveiling these price discrepancies wasn’t a simple task. Gathering complete and accurate healthcare pricing data presents a notable challenge for journalists. Indiana Public Media’s Joe Craft, one of the reporters on this story, highlighted the difficulty in obtaining reliable information. “For this story, we needed to be able to do two things,” Craft explained. “We needed to show how much care costs at this hospital and how that changed over the years.”
Craft pointed out that despite a federal mandate requiring hospitals and health insurers to publicly disclose their prices, many institutions haven’t complied.”Insurance companies want some of the data released as it helps them negotiate with hospitals, but also they don’t want to tick off the hospitals,” Craft elaborated, revealing the delicate balance of power dynamics within this complex industry.
This reluctance to share pricing information stems from the fact that healthcare pricing data is crucial to insurers’ negotiating power. As Craft astutely observed, “They don’t want anyone touching that data because it’s the bread and butter behind the power health insurers have in negotiations.” This leverage allows insurers to dictate terms with employers who ultimately bear the financial burden for their employees’ healthcare expenses.
Unraveling the Rise in Prices: A Comparative Analysis of Healthcare Costs
Deciphering Price Trends: Unveiling the Staggering Growth of Healthcare Costs
Beyond simply collecting price data, Craft’s next hurdle was to track how Parkview Health’s prices had shifted over time. He delved into academic literature and consulted with researchers specializing in the comparison between commercial rates (what employers pay) and medicare rates. This comparison, known as the commercial-to-Medicare ratio, sheds light on the premium prices charged by hospitals to private payers compared to government programs like Medicare.
“Essentially, this ratio shows how much more expensive the cost of care is for a private payer compared with what the government pays each hospital,” Craft explained.
To gain this valuable insight, the reporting team relied on data collected by the RAND Corporation, a reputable research institution. Since 2017, RAND has conducted surveys on behalf of employer coalitions, including the Employers Forum of Indiana, to analyze commercial rates. A recent RAND report published in May revealed the startling reality: “Employers pay 254% more for hospital care than Medicare, report says.”
“RAND makes available for purchase this big data set that includes the commercial to Medicare ratio,” craft shared. “A simple way to explain that is that they look at how much money is coming in through different channels to estimate what a commercial payer, such as an employer, would pay.”
Through this comprehensive analysis, the reporters uncovered a disturbing trend: for 10 out of the past 13 years, hospitals within the Parkview Health system consistently ranked among the most expensive in the country, on average. This alarming finding was based on their meticulous analysis of cost estimates from publicly available CMS data.
Furthermore, the reporters uncovered how Parkview Health’s aggressive expansion over two decades, acquiring six former rivals and establishing a vast network of healthcare providers, contributed to its dominance. This consolidation strategy allowed Parkview Health to exert significant control over patient referrals, effectively limiting competition and influencing pricing negotiations with health insurers.
Embracing Researchers’ Expertise: A Powerful Tool for Unveiling Healthcare’s Price secrets
Craft underscored the significance of adapting research methodologies for investigative journalism. “I am a big proponent of adapting methodology from researchers,” he said, emphasizing his belief in leveraging the expertise of those who specialize in navigating complex datasets. Years of experience working with intricate information allow researchers to identify pitfalls and implement rigorous data cleaning techniques that reporters may overlook.
“When I looked at the commercial-to-Medicare ratio, I got a lot of nonsense numbers as I hadn’t adopted some of their methodology to clean and narrow the data set,” Craft confessed, highlighting the potential for inaccuracies without proper methodology. He explained that hospital data from Medicare encompass a diverse range of facilities, including smaller hospitals and nursing homes, which can skew overall estimates.
“When you use researchers’ methodology and the cleaning steps they use that have been peer-reviewed, you get a much better and more defensible methodology,” Craft asserted. This approach not only strengthens the reliability of the findings but also provides a robust defense against criticism.
What steps can policymakers take to increase clarity in healthcare pricing and reduce the influence of consolidation on healthcare costs?
The Price of Healthcare: Inside Parkview Health’s Pricing Practices
Archyde News Editor: Joe, thank you for joining us today to discuss yoru recent investigative reporting on healthcare costs at Parkview Health. To start, can you outline for our readers the key findings of your investigation?
Joe Craft, Investigative Reporter, Indiana public media: Certainly. Our investigation revealed that over the past decade, Parkview Health, a prominent hospital system in northeastern Indiana and northwestern Ohio, has consistently demanded some of the highest healthcare prices in the nation. We found that for 10 out of the past 13 years, hospitals within the Parkview system ranked among the most expensive in the country, on average.
Archyde News Editor: that is a disturbing trend. What were the biggest challenges you faced in uncovering these price discrepancies?
Joe Craft: Obtaining reliable healthcare pricing data is a monumental challenge. While there’s a federal mandate requiring hospitals and health insurers to publicly disclose their prices,many institutions haven’t complied. Insurance companies want some of the data released as it helps them negotiate with hospitals, but they also don’t want to tick off the hospitals. It’s a delicate balance of power.
Archyde News Editor: So, essentially, there’s a lack of transparency built into the system?
Joe Craft: Exactly. They don’t want anyone touching that data because it’s the bread and butter behind the power health insurers have in negotiations.
Archyde News editor: How did you overcome these hurdles to gather the information needed for your report?
Joe Craft: We had to get creative. We leveraged data collected by the RAND Corporation, a reputable research institution. They conduct surveys on behalf of employer coalitions,including the Employers Forum of Indiana,to analyze commercial rates. Their data, including the commercial-to-Medicare ratio, proved invaluable in showing just how much more expensive care is for a private payer compared with what the government pays.
Archyde News Editor: The commercial-to-Medicare ratio- can you explain that a bit more?
Joe Craft: Sure. Essentially, that ratio shows how much more expensive the cost of care is for a private payer compared to what Medicare pays each hospital. ?
archyde News Editor: This is a very critically importent point. What do your findings say about the role of consolidation in healthcare pricing?
Joe Craft: Our investigation revealed that Parkview Health’s aggressive expansion over twenty years, acquiring six rivals and establishing a huge network of providers, contributed to its dominance. This consolidation allowed them to exert notable control over patient referrals, which limits competition and influences pricing negotiations with insurers.
Archyde News Editor: This raises serious concerns about the lack of competition possibly driving up costs for consumers. Do you see ways to address this issue?
Joe Craft: That’s a crucial question, and one policymakers are grappling with. increased transparency in healthcare pricing is paramount.
