Chargemaster

The patient faced bankruptcy because she couldn't pay off the hundreds of thousands of dollars accrued from her hospital bill, including a price from the chargemaster for a single acetaminophen pill at ten times the cost for the same pill over-the-counter at a pharmacy.

Much ink has been spilt bemoaning that incomprehensible foundation of hospital cost accounting and prices, the redoubtable chargemaster.

The higher the chargemaster markup over cost, the greater the potential for profit.

What a hospital is actually paid by an MCO, Medicare, or Medicaid is rarely even close to what is listed on the chargemaster. In fact, only the uninsured are subject to those charges.

Of particular importance, other than in Maryland, hospitals are generally free to charge whatever they want in their chargemaster.

California is a unique state in that all hospitals are required to submit a copy of their chargemasters, which the state then posts online for all consumers and patients to see.

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.