Episode 079: Health Care Price Transparency without an Executive Order with Dr. Bill Hennessey of Pratter

Real health care price transparency is a an elusive goal for many in the medical community.  Whether it is employers or individuals there is a real demand for people to want to know the prices of care before it is delivered. It might be imaging or common surgical procedures or laboratory work but ultimately, very few know how much their bills will be when they arrive a few months later. This lack of price transparency makes it difficult to be a conscientious consumer and drives people crazy.

That's where my guest today comes in, Dr. Bill Hennessey. Dr. Hennessey is the CEO of Pratter which is a medical consulting company that helps self insured companies/groups find affordable care. By using millions of claims in their database with government and commercial payers they provide their clients easy to understand reports on ways to save on their employees or member's medical care. This is accomplished mainly by redirecting people to lower cost options for imaging, surgery, and laboratory testing.

The main focus so far for the company has been to self insured employers and unions but Dr. Hennessey expects to launch a direct to consumer product of Pratter either later this year or early 2021. This release of prices for easily comparable services will revolutionize the health care market and disrupt the current system of multiple contracting with insurance carriers. I suspect even before the presidential executive order makes its way out of the courts it will already be moot as the market has shifted towards greater transparency from market pressure.

One example mentioned by Dr. Hennessey of the craziness of pricing is for inguinal hernia repairs by payer and location.

• Medicare for in hospital outpatient is $2783.
• Medicare for free standing surgical center is $2487
• Avg. Commercial payer for free standing surgical center is $2586
• Avg. Commercial payer for hospital outpatient is $5869!