Medical Pricing Analysis

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.

To learn more about medical pricing and our services or to schedule an appointment, contact TD&P Consulting, Inc., located in the Washington, D.C., Metropolitan Area, today.

[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).