Medical Pricing Analysis
What is a Medical Pricing Analysis?
A Medical Pricing Analysis involves the evaluation of medical goods or services purchased in the market. All medical goods, including unique items, require some review for cost or price reasonableness to verify whether the ‘actual’ price reflects the “fair and reasonable” value of that item. The purpose of employing a pricing analysis is to ensure that the buyer pays the seller a price that is not “too high or too low” for the item sold. A determination as to whether an expense is “reasonable” is a judgment that the proposed price is fair to both parties.
TD&P Consulting specializes in medical pricing analysis to determine price reasonableness for medical goods and services. We rely on medical literature, practice standards, and market data to build pricing models that are objective and comprehensive. An essential feature of our practice is evaluating benefit plan eligibility, the Affordable Care Act impacts, insurance coverage, state collateral source structures, and related factors that impact pricing.
In general, a pricing analysis involves the comparison of market prices. And employing similar pricing techniques as a tool for measuring price reasonableness is widely accepted as a means for ensuring that patients in the healthcare market pay “fair and reasonable” prices.[1]
The popularity of TD&P’s approach has grown in recent years as courts steadily raise the evidentiary bar for the admission of cost data. (See People v. Sanchez, 63 Cal.4th 665 (2016)). Nowhere is this more evident than in personal injury cases involving the testimony of life care planners, who are often asked to testify about future medical expenses. As the progenitor of the leading methodology for evaluating medical necessity and valuation of medical costs, TD&P is uniquely qualified to assist you in the development of your case.
[1] Alexander Willison Pecci. “Price Shopping is Influencing Healthcare Choices.” Health Leaders Media. https://www.healthleadersmedia.com/finance/price-shopping-influencing-healthcare-choices (September 27, 2018) (Last visited 9-8-2019).
Thomas J. Dawson III leads the medical pricing analysis department. Mr. Dawson has served 30 years providing services as a health policy professional. Highly accomplished with an extensive background in healthcare finance, regulatory compliance, healthcare policy involving Medicare, Medicaid, health insurance reform, and the Affordable Care Act. Sophisticated in managed care, small and large group health insurance, healthcare reimbursement policy, ERISA, government legislative processes, project management, and communication. Wide-ranging experience as a leader, and organizer with demonstrated ability to execute major cases in a well-timed manner. Serves as an expert witness in federal and state court and has offered opinions on matters involving medical costs, health insurance, reasonable value, and the Affordable Care Act. Read more on Thomas Dawson.
To learn more about our Medical Pricing Analysis, contact TD&P Consulting, Inc. at info@tdphealth.com or call (877) 420-8680.