Scripps' Epic EHR automates supply price markups up to 675% 

Scripps Memorial Hospital's Epic EHR uses an automated tool to mark up prices of supplies between 575 and 675 percent in real time within the EHR, The Los Angeles Times reported Dec. 10. 

A former nurse at the Encinitas, Calif.-based hospital shared screenshots of Scripps Memorial's EHR from earlier this year with the Times to show the price hikes being automatically generated by its Epic EHR. Epic told Becker's on Dec. 13 that it does not comment on how customers use its proprietary systems. 

Some of the screenshots shared with the Times show an automated formula for marking up the price of sutures, the basic cost per unit of which Scripps' EHR lists at $19.30. However, the computed charge per unit, or how much the patient and their insurer would be billed, is $149.58. 

Scripps' EHR automation tool uses the following equation to calculate the price for sutures: "$149.58 = $19.30 + ($19.30 x 675%)," according to the report. 

Epic lists the charge from the chargemaster, a Scripps spokesperson told Becker's on Dec. 13, adding that the health system provides a discount for cash payments if a patient does not go through an insurance company. If the patient does not have insurance or is underinsured and can't afford to pay, Scripps said it helps pay for or covers the cost through its charity care program. 

"Like most healthcare providers and insurance companies in the United States, Scripps Health operates under a system that was established decades ago and which is outdated," the hospital spokesperson said. "It works like this: A healthcare provider determines charges (the 'charge master' or 'CDM') for its medical services — the list prices are independent of what commercial and government insurance contracts pay. At Scripps, we benchmark CDM pricing in our marketplace to make sure we set our list prices competitively." 

Scripps said it negotiates with payers for what it will be paid for services, similar to most other providers. Payers then determine separately from providers what they will cover versus what patients will pay, and "neither the insurance company nor the patient typically pay list price," the health system said.

 

Copyright © 2022 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Featured Whitepapers

Featured Webinars