Hospitals are under pressure to justify cost shifting.

You hear it over and over like a recording: Cost shifting is essential to recover losses from Medicare, Medicaid and charity care. But the days of cost shifting as implicit and accepted social policy are over. Payers are looking at hospital profits and resisting the time-honored argument for higher charges. Coalitions of businesses are pooling data to challenge hospital hard-luck stories. Still want to blame prices on the usual demons? Be prepared to prove it.