EP389: The Clapback When Hospitals Cannot Constrain Their Own Prices, With Mike Thompson

The Clapback When Hospitals Cannot Constrain Their Own Prices, With Mike Thompson (EP389)

Why Nonprofit Status Lets Some Hospitals Avoid Market Discipline on Pricing. Episode 389.

Stacey Richter talks with Mike Thompson, CEO and president of the National Alliance of Healthcare Purchaser Coalitions, about why nonprofit status shields some hospitals from FTC scrutiny and financial discipline—and what employers can do to push back on unfair pricing.

WHAT YOU'LL LEARN

✅ Why nonprofit status excludes some hospitals from the FTC enforcement powers other industries face

✅ How overbuilding infrastructure, like extra MRI machines, can trigger a downward spiral into anticompetitive pricing behavior

✅ Why there's no correlation—and sometimes an inverse one—between high hospital prices and high quality

✅ The National Alliance's five-strategy playbook: check the fair commercial price, use reference-based pricing, monitor your ASO/TPA, join employer coalitions, and pursue legislation

✅ What the Sage Transparency dashboard shows about the gap between what hospitals charge and a fair commercial break-even price

✅ Why regulating uncooperative nonprofit hospitals like utilities may become a necessary last resort

WHY THIS MATTERS

When nonprofit status insulates a hospital from both market competition and antitrust enforcement, patients, employers, and taxpayers absorb the cost. Thompson's playbook gives purchasers concrete tools—starting with knowing the fair local price—to push back instead of just paying whatever gets billed.

MENTIONED IN THIS EPISODE

EP372 with Cora Opsahl: Apple Podcasts | Spotify | Other Apps

EP358 with Wayne Jenkins, MD: Apple Podcasts | Spotify | Other Apps

EP388 with Merrill Goozner: Apple Podcasts | Spotify | Other Apps

EP346 with Peter Hayes: Apple Podcasts | Spotify | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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00:00 Introduction.

05:37 Check EP372 with Cora Opsahl; EP358 with Wayne Jenkins, MD; EP388 with Merrill Goozner; and EP346 with Peter Hayes for a deep dive.

05:48 Why should an employer health plan be concerned about how much area hospitals are spending?

07:01 How are hospitals quantifying their prices?

08:10 "I think we're not paying a fair price is the end game."

10:45 How do we bring rigor back into the market?

11:12 What is NASHP?

15:10 What does the NASHP commercial breakeven take into account?

18:24 Why are hospitals conflicted when it comes to building a health system based on value and health?

20:17 Why is the onus on hospitals to defend the way they've spent the money they have?

21:58 "Where there are market dynamics, we typically see prices in that fair price range."

25:06 What can employers do from a market standpoint, a program design point, and a policy standpoint?

27:11 What is the National Alliance of Healthcare Purchaser Coalitions playbook?

30:15 Why is changing the dynamics in the press important to changing hospital pricing?

33:02 How fundamental is the employer's role in making sure that they're paying a fair price for the healthcare services their employees are receiving?