What the national reference points say
The most cited national reference is RAND's hospital price study, which has consistently found commercial prices for hospital care running well above Medicare — on the order of 250% of Medicare on average, with very wide variation across states and systems. For physician services the multiple is lower and more variable. These are useful anchors, but they are national averages that conceal enormous local variation.
A national multiple tells you the weather, not your forecast. The number that matters is your market, your service line, and your payer — which is rarely the national average.
Reading a benchmark without being misled
- Match the setting. Hospital, HOPD, ASC, and office multiples are not interchangeable.
- Match the service mix. A blended multiple hides that some codes pay well above and some below.
- Adjust for acuity. A higher multiple can simply reflect higher-acuity case mix, not richer rates.
- Localize. Market concentration, on both sides, drives more variance than any national figure.
An illustrative benchmark frame
| Segment | Illustrative commercial % of Medicare | Read with caution because… |
|---|---|---|
| Hospital inpatient | ~200–300% | Acuity and market concentration dominate |
| Hospital outpatient | Wide range | Site-of-service steering is repricing this now |
| Physician / office E/M | ~120–160% | Specialty mix drives most of the spread |
| Hospital-based specialties | Compressed | No Surprises Act / QPA linkage caps upside |
Illustrative reference frame only — not published Fulcrum benchmarks. Your figures should be built from your contracts and claims.
From benchmark to negotiating position
A benchmark becomes leverage only when it is your benchmark: built from your claims, matched to your service lines, and localized to your market. The deliverable that moves a negotiation is not 'the market pays 250%' — it is 'for this service line, in this market, against this payer, your rate sits at the Xth percentile, and here is the value that justifies moving it.'