Your Health System Doesn’t Want You to Understand Their Charges

View From the Front Porch. There is a Hummingbird Tail Hanging down on the Feeder.

Prisma Health is a huge healthcare system that dominates a good part of my home state, South Carolina. It certainly is the primary healthcare force in the upstate and the center of the state around the capitol, Columbia. It generate $5.7 billion operating revenue with almost 3,000 beds in 18 hospitals and nearly 3000 employees serving 1.5 million patients. The population for the entire state is 5 million. I live in the Greenville, SC area and they are my provider.

They provide care for 30% of the state’s entire population. Healthcare quality and cost has a huge impact on the state’s economy. It matters for every South Carolinian. That is one of the factors any business considers when they decide to locate in a state. That makes a recent story in the news worrisome.

Christin Deacon is an attorney who served as assistant attorney general for the State of New Jersey and assistant director in the state Division of Pensions and Benefits there. She understands healthcare and she is now a widely respected and effective advocate for healthcare reform. Here is a quote from her on LinkedIn about a dispute between Prisma and UnitedHealthcare.

“Prisma alleges UnitedHealthcare revealed their confidential rate proposals, which included a significant 24% rate hike over 15 months. This isn't just a mere contractual squabble; it's emblematic of a larger issue. While United may have been wrong to air the parties' negotiating positions, Prisma's concession that public awareness of its prices would cause irreparable harm is the true headline here. Prisma categorically states that when their prices are made known, including their 2024 rate hike requests, public outrage ensues and they suffer reputational harm.

The vehement resistance from hospitals like Prisma to disclose rates transparently highlights an unsettling truth: the depth to which hospitals may go to shield their financial strategies, even at the potential cost of public trust. As the industry navigates this path, it becomes clear: we must prioritize patients and transparency above all else.”

Here is the curious thing. There is a law that requires hospital systems to reveal their prices. There is another law that imposes a fiduciary duty on employers like BMW and Michelin in Greenville to assure that their employees receive effective care at a low cost. Despite these clear legal requirements, employers cannot meet these obligations because insurance companies and large hospital systems make it extremely difficult to get access to their charges, fees, and financial arrangements. This situation must be very frustrating for BMW which is a German company. Most Germans are also insured by their employer, but elected representatives from employees and employer decide what the priorities are and have access to all the data.

Big health systems like Prisma are proving they will never give us better health at lower cost Prisma care is almost entirely delivered in palatial brick and mortar facilities that require your personal attendance with an appointment made months in advance. As I wrote in the last post, the biggest need for American patients is optimal medical therapy (OMT) for chronic diseases delivered by advanced outpatient primary care teams. OMT cuts medical costs in half while cutting hospitalization by 80% and ER visits by 2/3. Most of that care can be delivered remotely and Prisma is doing nothing to make OMT available to the people they serve for obvious reasons. Our healthcare system is broken. It is time to do something about it.