Medical Pricing Analysis

What is a Medical Pricing Analysis?

A Medical Pricing Analysis is the purchase of goods or services in the market, including unique items, require some cost or price reasonableness analysis to verify whether the price is “fair and reasonable.” The purpose of employing a pricing analysis is to ensure that a buyer pays a seller a price that is not “too high or too low” for the item sold. A determination that a price is “reasonable” is a judgment that the proposed price is fair to both parties.

TD&P Consulting specializes in medical pricing analysis for medical goods and services and determining price reasonableness. We rely on medical literature, policy, and market data sources to develop pricing models that are systematic, comprehensive and objective. An essential feature of our work is the ability to carefully evaluate 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 ((1) to each other, (2) to prices found reasonable on previous purchases, or (3) to an independent market estimate). 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 on future medical expenses. As the progenitor of the leading methodology for the evaluation of medical necessity and valuation of medical costs, TD&P is uniquely qualified to assist you in the development of your case.

Thomas J. Dawson III, Esq., MPH, MA
Thomas J. Dawson III, Esq., MPH, MA

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 admin@tdphealth.com or call (877) 420-8680.

[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).