Health systems have been the majority of price transparency early adopters (thanks, srsly) but today we wanted to switch gears and draw attention to how specialty providers are using it.

So: freestanding imaging center, an independent ASCs, a behavioral health practice, a mental health clinic, or a rural critical access... this one’s for you.

What data does a specialty provider need?

Since we’ve spent the last three years collecting (read: hunting) data, we now have rates from over 240 payers and 5,400 hospitals sorted and organized in one place. That’s a lot, and some might argue, much too much for the average specialty provider. And, you’d be right. All this There’s-a-Lot-Of-Data chatter has likely caused smaller providers to not even think about using it to their advantage. And further, who can even afford it at all? Smaller providers don’t need everything and the kitchen sink–they usually just need rates from a few codes for a few payers and BOOM! they can change the world. (Okay maybe not the world, but like, a lot.)

For example, say you’re a Tacoma, WA-based surgery center and you suspect you're being underpaid for an arthrotomy with meniscus repair (CPT 27403). To figure out if you’re actually being underpaid, what you need are 27403 rates for Tacoma, WA from the payers you’re contracted with.  

We call these Custom Rates.

So once you’ve logged in, you can first look at the rate for ASCs like yourself. In this example below we’re pulling both professional and institutional rates so you can get an idea of cost based on the rate type you care most about.

Payer Rates for 27403 for ASCs

Next, you’d swap out your Provider Grouping filter to “Hospitals” and see what changes.

Payer Rates for 27403 for Hospitals

We can see a pretty significant difference in rate! This probably won’t surprise you since ASCs are typically paid less for the same service than hospitals. But that’s a pretty big discrepancy. You could either dig deeper and toggle to the “Search” tab and look at exact rates by hospital. There you could look at the differences in rate by institution by payer. Or, you could simply take the benchmark rates and do some connecting.  Are most of your contracted rates with the payer paying the lowest amount for the same service regardless of the provider group? Or are you getting significantly lower than your neighbors from the same blue-shielded payer?

Knowledge is power! If you’re a surgery center that specializes in only a couple of codes, these two screenshots would be enough to totally restrategize your pricing. You don’t need the kitchen sink, you need a cocktail fork.

Price transparency data can change the landscape for you

Price transparency will not simplify healthcare if it doesn’t reach into each local community. There are thousands of specialty providers, rural hospitals, and smaller payers (like unions and self-funded employers) who need access to this data.
At the end of the day, everyone wants quick access to the most relevant data.

Want to chat about the data you’re interested in? We’re all ears.