Setting aside the fact that contracts commonly contain confidentiality language, the real obstacle to RBMA acting as a clearinghouse for rate information, and to groups using it, is the risk of running afoul of anti-trust law. I'm not a lawyer, but as I understand it, if RBMA gathered and published data about contract rates, and groups started negotiating based on that data, there could be charges of illegal collusion.
There is certainly history of other similar organizations facing charges of price fixing as a result of these kinds of activities, and most try to steer well clear of them. It's pretty surprising that the anesthesia group would venture into that minefield.
If you operate within the law (i.e. negotiate independently), then I don't think knowing what others get paid would materially change your negotiating position. If I know what the other groups in my market are getting, I don't think it would change much, because they are situated differently in terms of their service mix, scale, market coverage, hospital affiliations, etc. My goal is to optimize our reimbursement for my groups situation, and what others are getting isn't really relevant to me...nor can it be. Of course, if a payor is offering something below what we get from their peers, I won't hesitate to use that information.
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David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387
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Original Message:
Sent: 06-02-2021 08:12
From: R. Christopher Sluder
Subject: Private Payer Rates
I've been around awhile and have always operated under the rules of an individual group's contracted rates should always be kept confidential. But I think we also have to understand the current environment. Seems everyone is pushing for more transparency on contracted rates. Hospitals are suppose to disclose their rates openly on their website for all payers. I hear comments sometime about radiology groups preparing for their hospitals to start requesting the radiology group do the same. Makes me wonder if we're to the point where the confidential nature of our respective contracted rates may be changing.
Just my thoughts on this topic......Chris
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R. Christopher Sluder CPA
Administrator
Rome Radiology Group
Rome GA
Original Message:
Sent: 06-01-2021 10:19
From: Gregory Benke
Subject: Private Payer Rates
I am new to RBMA. I am trying to find surveys/statistics on insurance payer rates and don't see them on this website. I am a part of a multi-specialty group in Central Florida. The anesthesiologists in our group are able to see detailed insurance payer rate information for groups through their equivalent anesthesia business association.
I am wondering if anybody knows if this data is already available on the RBMA website. If not, I wonder if anybody would be interested in the creation of such a document. We could anonymize data and create a spreadsheet showing ranges and averages for insurance payer rates (e.g. BCBS @ 150% of medicare, etc). Also perhaps break them down by location and rural/urban settings.
Is this data available already? If not, should we work on putting it together for groups to use as a reference/place to start when negotiating payer rates with insurance companies?
Thanks,
Greg
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Gregory Benke MD
Diagnostic Radiologist/Co-Chair of BPA Radiology
Brevard Physician Associates
Melbourne FL
(321) 837-3820
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