Cost Containment Case Study: Cardiac Shock

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June 18th, 2012
Categories: Case Studies

A male tourist from the UK was rushed to the hospital on the west coast while traveling in the United States. The hospital ran a series of costly tests to diagnose a cardiac condition. The expense to run these tests and stabilize the patient was an alarming $158,000. Shortly after being discharged from the hospital, the patient continued to experience chest pain and was taken to another hospital where he underwent surgery for his cardiac condition. The  total fees for the surgery and hospital stay were nearly identical to the previous facility which had only performed a round of testing in order to diagnose the patient.

PayerFusion received this case after the-fact. We were immediately concerned by the amount charged for the first hospital visit and testing, noting the contrast of cost to the actual surgery that had taken place in the second facility. Working with both facilities and by utilizing our Cost Plus Methodology, we were able to adjust the cost of service and reach an agreed fair price, a 73% overall reduction in billed charges, resolving the situation for our client, the providers, as well as the patient.

Our Cost-Plus Methodology determines the actual cost of care by analyzing the type of facility, size of facility, type of treatment and by actual share of unfunded or underfunded care that requires them to cost-shift.  We analyze this data using a unique algorithm, and start savings calculations  based on “clean” claims that have been scrubbed of any fraudulent charges, errors or charges for clinically unnecessary procedures. This methodology aims to provide our clients a clear advantage in negotiating fair and sustainable savings that results in true cost containment.  We share more in-depth information about our Cost-Plus Methodology in a previous post, breaking down the data we review.

It is PayerFusion’s mission to ”fuse” the gap between providers who deserve fair compensation for quality care and payers who seek fair prices for medical services rendered. If you would like more information on joining our network of providers, or becoming one of our clients, please visit Providers or Payers for more information.