Don’t hate on hospitals: Navigating the complexities of healthcare reimbursement with Jugna Shah, MPH

Stop hating on hospitals. It’s a sentiment most Off the Record podcast listeners would probably agree with. But not everyone. Hospitals are under assault in some corners, including the media and in the halls of government. We need a villain and hospitals often find themselves playing the role of fall guy. For example, many blame them for out-of-control healthcare costs, citing a lack of cost transparency and exorbitant charging practices. Jugna Shah, MPH, founder and president of Nimitt Consulting, Inc. pushes back on these assertions, making a compelling case that a broken system is to blame. Hospitals own a piece of the problem, but by and large are doing their best to navigate inadequate and complex rules and opaque payer requirements. Many of the gotcha soundbites on Twitter, especially ones that place full blame on hospitals, are misguided, she says. On this show we cover: • Jugna’s unique path into healthcare and hospital advocacy • Pricing transparency: The problem with posting prices, and the real reason why outrageous hospital charges exist • Why and how hospitals must charge to get adequately reimbursed for CAR-T and other expensive therapies, drugs, and services • Site neutral payments. Why should hospitals be paid multiples of the same procedure done at an ASC down the street? There are reasons… • Fighting back against payer denials of packaged/bundled services • Best practices for commenting to CMS and making your voice heard