Talk:chargemaster

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chargemaster, created entry[edit]

Created entry for chargemaster, with quotes from three (3) sources to start. -- Cirt (talk) 21:23, 5 March 2013 (UTC)

  • How very, very strange. SemperBlotto (talk) 22:15, 5 March 2013 (UTC)
    • How so? -- Cirt (talk) 01:12, 6 March 2013 (UTC)
      • In civilized countries, hospitals are free. SemperBlotto (talk) 22:30, 8 March 2013 (UTC)
        • In France they're not. Oh wait you said civilized, never mind. Mglovesfun (talk) 22:34, 8 March 2013 (UTC)
          • Yes, well, the United States healthcare system is certainly very far from ideal. -- Cirt (talk) 23:07, 8 March 2013 (UTC)
  • I'm not sure that the definition is NPOV (or whatever we call it around here) JulieKahan (talk) 18:16, 6 March 2013 (UTC)
Thanks for your input, but the definition is based on multiple reliable secondary sources including academic authoritative sources like health economists. -- Cirt (talk) 22:05, 6 March 2013 (UTC)

I don't know if the prices that hospitals charge are reasonable or not, nor how we would calculate that, but less us suppose that a given hospital in fact charged reasonable prices to patients or their insurers. Would their list of charges be a "chargemaster?"Nedarim (talk) 08:38, 8 March 2013 (UTC)

Heheh, well, you'd have to find such an instance of usage, first. All reliable academic secondary sources and scholarly analysis by health economists that I've come across in my research, suggests otherwise. -- Cirt (talk) 18:24, 8 March 2013 (UTC)
Is "often with highly inflated prices at several times that of actual costs to the hospital." part of the definition or just incidental information? Mglovesfun (talk) 18:49, 8 March 2013 (UTC)
Part of the definition. -- Cirt (talk) 22:24, 8 March 2013 (UTC)

I have removed "with highly inflated prices at several times that of actual costs to the hospital", as I do not see quotations that support this particular differentia of the definition. Please indicate which of the quotations that you provided you think support this particular differentia. --Dan Polansky (talk) 11:14, 9 March 2013 (UTC)

Take the following quotation: "Hospitals readily admit that chargemaster prices are inflated." I am far from sure that this sentence implies that containing inflated prices is part of the definition of "chargemaster". If it did, "chargemaster prices are inflated" would be a tautology with no empirical content, just like "bachelors are unmarried". But even if we admit that "with highly inflated prices" is part of the definition of "chargemaster", I gravely doubt that "at several times that of actual costs to the hospital" is part of the definition, and that this is supported by quotations. --Dan Polansky (talk) 11:25, 9 March 2013 (UTC)
Please, do not remove this part of the definition. It is integral to the definition. I have provided many more quotes with citations at Citations:chargemaster. -- Cirt (talk) 22:05, 9 March 2013 (UTC)
As far as I can see, not a single of these quotations supports the differentia. Please single out one of these quotations so we can discuss how that quotations supports the definition. --Dan Polansky (talk) 22:35, 9 March 2013 (UTC)
  • 2013 February 20, Steven Brill, “Bitter Pill: Why Medical Bills Are Killing Us”, Time, Time Warner, retrieved on March 4, 2013:
    However, I quickly found that although every hospital has a chargemaster, officials treat it as if it were an eccentric uncle living in the attic. Whenever I asked, they deflected all conversation away from it. They even argued that it is irrelevant. I soon found that they have good reason to hope that outsiders pay no attention to the chargemaster or the process that produces it. For there seems to be no process, no rationale, behind the core document that is the basis for hundreds of billions of dollars in health care bills.
I strongly suggest you read this entire cited article, linked above, and then get back to me here about what you think the definition should be, okay? -- Cirt (talk) 04:46, 10 March 2013 (UTC)
This quotation fails to attest having inflated prices as being part of the definition of "chargemaster", IMHO. You don't even learn from this quotation that the prices on the chargemaster are inflated, let alone learn that they are so at several times the cost to the hospital. But even if you did learn that, that would not automatically make it part of definition. Rather obviously, not every fact about a thing is part of the definition of the thing. For instance, from the quotation, you learn that every hospital has a chargemaster, yet you do not make this a part of definition. You also learn that "the officials treat it [the chargemaster] as if it were an eccentric uncle living in the attic", but that is also not in the definition you've created. Anyway, I have sent the disputed part of the definition to RFD. --Dan Polansky (talk) 08:14, 10 March 2013 (UTC)
Request: Please, Dan Polansky (talkcontribs), I ask of you to read this article:
I think that will give you some clarity about the term chargemaster. Thank you for your time, -- Cirt (talk) 18:24, 10 March 2013 (UTC)

Grammar[edit]

I think this is wrong: "highly inflated prices at several times that of actual costs to the hospital." What does "that" refer to? The "prices" and "costs" are both plural. Equinox 11:35, 10 March 2013 (UTC)

Think I've fixed it. Equinox 14:44, 10 March 2013 (UTC)
Thank you. -- Cirt (talk) 18:19, 10 March 2013 (UTC)

Example sentence[edit]

The current sentence is not very useful; removing "chargemaster-derived" would hardly change the meaning at all. Something like "The chargemaster listed a price of $100 for a bottle of aspirin" would still get your point across. JulieKahan (talk) 14:28, 10 March 2013 (UTC)

Thank you, I've incorporated your suggestion to improve the example sentence, it's a bit better now. And the chargemaster typically will not charge for an entire bottle of aspirin, but a single pill can often cost as much as an entire bottle would. -- Cirt (talk) 18:22, 10 March 2013 (UTC)
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The following discussion has been moved from Wiktionary:Requests for deletion.

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chargemaster

I am requesting deletion of this part of the definition: ", with highly inflated prices at several times that of actual costs to the hospital."

Quotations allegged to support the definition including this part of it are at Citations:chargemaster. One quotation has been singled out by the creator of the entry at Talk:chargemaster, upon my request.

At the very least, "at several times that of actual costs to the hospital" should be dropped from the definition, IMHO.

The complete definition:

  • "a comprehensive listing of items billable to a hospital patient or a patient's health insurance provider, with highly inflated prices at several times that of actual costs to the hospital."

--Dan Polansky (talk) 08:04, 10 March 2013 (UTC)

Request: Please, Dan Polansky (talkcontribs), I ask of you to read this article:

I think that will give you some clarity about the term chargemaster. Thank you for your time, -- Cirt (talk) 18:18, 10 March 2013 (UTC) Note: Please note that it is integral to the definition of chargemaster that the chargemaster prices are extremely inflated and exorbitant. Please see the following cites for this fact:

  • 2005 January 3, The Star-Ledger editorial board, “Post hospital prices”, The Star-Ledger, page 14:
    Hospitals readily admit that chargemaster prices are inflated . That's because they are the starting point for negotiating the discounts given to private insurance plans in return for the volume of patients they send to a hospital. Those bloated chargemaster prices, however, are the numbers used to bill uninsured patients - many of whom will struggle to pay those bills and will get nasty collection letters if they don't.
  • 2007 May 14, Medicine & Health staff, “Picking on the poor: hospitals charge uninsured patients more: self-pay patients pay 3 times more than Medicare-allowable costs”, Medicine & Health, volume 61, number 19, Eli Research, Inc., page 1: 
    In addition to patients without insurance, hospitals also charged international visitors and patients with health plans through insurers that haven't negotiated hospital discounts approximately two and a half times the price offered to health insurers with discounts, the report estimates. These inflated bills base their prices on a hospital's chargemaster file, an undiscounted master list of the prices hospitals set for services.
  • 2007 September 23, Naples Daily News staff, “Nonprofits hope IRS more responsive to them”, Naples Daily News:
    The finance committee report also recommends that bad debt not be allowed to be included as charity care. '[United States Senate Committee on Finance] Staff views it as inappropriate for a hospital to seek payment from a patient by sending a bill, (and) when payment is not received, to seek to recharacterize that debt as charity care. In addition, staff has found that the decision by some hospitals to include bad debt which often consists of very high charges from the ( chargemaster list) provides a misleading and inflated accounting of a hospital 's charity care to policymakers and the public.'
  • 2004 July 1, Rebecca Vesely, “Sutter Health sued for overcharging”, Tri-Valley Herald:
    These gross prices are listed on spreadsheets called chargemasters, and are typically used as a starting point in negotiations over fees in much the same way the sticker price of a car is the initial bargaining point at an auto dealership. The chargemaster prices are typically negotiated downward to reasonable reimbursement rates for private insurers and public programs such as Medi-Cal and Medicare, according to the suit. Not so for uninsured patients of Sutter hospitals , who are billed the full sticker price, which can be 80 percent higher than the industry standard, according to the suit.
  • 2006 January 1, Christopher P. Tompkins, Stuart H. Altman and Efrat Eilat, “The Precarious Pricing System For Hospital Services[1], Health Affairs, volume 25, number 1, DOI:10.1377/hlthaff.25.1.45, retrieved on March 7, 2013, pages 45-56: 
    Perhaps worst of all, billed charges can be perceived as shocking, or even punitive, to the uninsured. As hospitals increasingly raised their charges and set prices by negotiating discounts from their chargemasters, those with the least bargaining power received the smallest discounts. An unfortunate consequence of this system is that self-payers, including the uninsured, were usually forced to accept the charges that hospitals stipulated. This created, probably inadvertently, a rather pernicious outcome in which patients who had the least ability to pay for their health care were charged the highest prices. This has resulted in considerable problems for some patients with very high health care personal debt, aggressive efforts at collection, and avoidance of needed services.
  • 2008, T. Neil Davis, Mired in the Health Care Morass, Ester Republic Press, ISBN 0974922145, page 66:
    The higher the chargemaster markup over cost, the greater the potential for profit.
  • 2011 October 24, Indianapolis Business Journal staff, “Judge slaps IU health over billing uninsured patients”, Indianapolis Business Journal, Indianapolis Business Journal Corp., volume 32, number 34, page 13A:
    It has been common for hospitals to raise their chargemaster rates substantially each year in an effort to win higher reimbursement rates from health insurers. But the practice falls hard on uninsured patients, because most hospitals give no more than a 20-percent discount to the uninsured.
  • 2013 February 24, Bloomberg View editorial board, “Bringing Down Health-Care Costs Isn’t Always Complicated”, Bloomberg View, retrieved on March 7, 2013:
    Chargemasters contain laughably high prices that hospital administrators don’t even try to justify. (They don’t seem to know how they were set to begin with, and argue that they’re misleading because insurance companies always negotiate lower ones.) Yet people without insurance, or with too little insurance, often end up paying chargemaster prices.
  • 2010 March 14, Roswell Daily Record staff, “Lawsuit alleges hospital unfairly bills uninsured”, Roswell Daily Record:
    The Sisneros suit is a counterclaim to a civil case filed by ENMMC against him, for failure to pay a $12,730 hospital bill for treatment. The counterclaim accuses the hospital of inflating its chargemaster rates, or the standard costs for any given procedure, in an effort to engage in "turbocharging."
  • 2011, Sandra J. Winterhalter, “Economic factors converge: force hospitals to review pricing strategies”, Journal of Health Care Finance, volume 37, number 4, page 15: 
    Bills that include chargemaster prices are not a true reflection of actual price and if paid at the chargemaster list price would yield extremely large profits for the hospital. (50) It can be argued that because hospitals accept different payments from different payers for identical services, hospitals engage in price discrimination--the practice of charging different customers different prices for identical goods or services.
  • 2013 February 28, Dr. Sreedhar Potarazu, “ObamaCare Gold Rush: The winners and losers”, FOX News, retrieved on March 7, 2013:
    There are no current measures in ObamaCare that will help Medicare and the private market gain better transparency on the "chargemaster" of hospitals and until this happens, there are many hospital executives who will continue to bring in enormous salaries at the expense of the market and consumers.

This should be included as part of the definition. It is integral to the definition itself.

Thank you for your time, -- Cirt (talk) 18:30, 10 March 2013 (UTC)

I don't think these quotations support the questioned part of the definition. It may well may be true that chargemaster prices are highly inflated, but that does not automatically make that a part of definition. The volume of quotations that you have provided does not help, IMHO. If a quotation does not attest the questioned part of the definition, it should not have been listed. You have listed "The higher the chargemaster markup over cost, the greater the potential for profit", as if that was telling us anything new that we did not know about any pricelist, highly inflated or not. I rest my point, and say delete the questioned part. --Dan Polansky (talk) 19:28, 10 March 2013 (UTC)
Delete, exactly as nominator suggests, as much as I despise the US system for ripping off uninsured private-pay patients. DCDuring TALK 20:19, 10 March 2013 (UTC)
Delete the disputed part of the definition. Whether the prices in the chargemasters are "highly inflated" is encyclopedic or journalistic information that doesn't belong in a dictionary. We should just define what a chargemaster is and leave the value judgments- however well-founded or well-supported- to other venues. Besides, it's possible for a chargemaster to not have high prices and still be a chargemaster, though that may not normally be the case. Chuck Entz (talk) 22:27, 10 March 2013 (UTC)

DONE: Trimmed the definition to that suggested by Dan Polansky (talkcontribs), above, please see DIFF. Hopefully this is now satisfactory to Dan Polansky (talkcontribs). Thank you, -- Cirt (talk) 23:40, 10 March 2013 (UTC)

The current definition, "a comprehensive listing by a hospital of prices of items billable to a hospital patient or a patient's health insurance provider", is incorrect according to my own understanding (which is based solely on reading that Time article) and the cites above. AFAICT the chargemaster is a master list of prices kept by the hospital, and has nothing to do with any one patient. The definition should be changed to "a comprehensive list maintained by a hospital of prices of goods and services it will bill to its patients and their respective health insurers" or something else.​—msh210 (talk) 06:36, 11 March 2013 (UTC)

Done. Please see DIFF, implemented the suggestion by Msh210 (talkcontribs) for the definition, above. -- Cirt (talk) 15:43, 11 March 2013 (UTC)
From what I have understood from the linked articles, chargemaster contains prices billable to uninsured patients, whereas the prices charged to health insurance providers are dramatically lower than those contained in the chargemaster. As far as definition is concerned, it remains to be clarified whether things called "chargemaster" were always so, and are necessarily so. If each and every chargemaster in a hospital is intended only for uninsured patients, this could possibly be in the definition. Whatever the case, the original complaint of this RFD has been solved: the disputed part of the definition has been deleted. --Dan Polansky (talk) 19:28, 11 March 2013 (UTC)
Thank you. -- Cirt (talk) 20:30, 11 March 2013 (UTC)
Yeah, striking, detagging.​—msh210 (talk) 05:16, 12 March 2013 (UTC)
@Dan: the chargemaster has the prices that everyone is charged. Larger customers like HMOs have the clout to negotiate those prices down, so they end up paying a much lower amount. Uninsured patients have no clout, so they can't get the hospitals to budge on the price. The result is that the uninsured patients pay full retail, while the HMOs pay at a heavy discount- but everyone starts at the same price. In other words, the chargemaster is the standard list price for everything the hospital provides, before all the discounts, etc. are applied. Chuck Entz (talk) 06:32, 12 March 2013 (UTC)
Thank you, Chuck Entz (talkcontribs), that's a pretty good background description. -- Cirt (talk) 13:47, 12 March 2013 (UTC)