For someone who worked on price transparency in 2013 - I was personally affected with surprise billing - and spent long hours working on a price discovery / transparency tool called pricepain.com, this (first step of an) anti cartel measure brings tears of joy. While it won’t solve all issues at once, shining some light into the medical billing mess can only be a good thing, allow market forces to enter the picture somewhat. It’s rather sad, that it didn’t come from the industry itself - but I guess that speaks volumes already.
Florida faced a dilemma with their incredibly broken public school system many decades ago and was stuck in a political gridlock as no party agreed on any measure the other would propose to improve the situation. Finally, the only item both parties did agree on, was to grade schools. Just a single simple letter, a search for more light. The result of a little bit more transparency caused a chain reaction of consequences leading to higher quality of service overall. I hope that similarly this move will spark a quality/performance re-orientation and help create more Surgery Centers of Oklahoma. It’s high time.
Hospital prices are about to go public in the U.S.
171–180 of 390 posts
Re: Hospital prices are about to go public in the U.S.
#172Pro tip: I was a neurosurgical anesthesiologist at the University of Virginia Health Sciences Center for twelve years (1983-1995). Every now and then I'd get a call from our billing office that they'd received a letter from a patient I'd cared for who was too poor to pay what our department had billed (usually many thousands of dollars: I had NO IDEA what our charges were, BTW, nor did any of my colleagues in the department). Every time that happened, I'd go over to the billing office and — without bothering to read the letter — tell our billing chief to waive all anesthesia-related charges. In other words, by my initialing a form we had, their balance due us was 0. Try it, you never know, it might work for you.
Re: Hospital prices are about to go public in the U.S.
#173Earlier quoted context omitted.
> It's a total mess and hopelessly complex for the average consumer. But not for insurance companies; it's in their interest to compare hospitals and get the best care for the lowest price. I for one hope this will trigger competition. On the other hand, it'll probably end up shafting the personnel instead of the ridiculous profit margins.
The idea of effective competition in emergency services has always struck me as fanciful. The benefit that competition provides to incentivize lower prices and better services is a consumer's ability to easily deny someone their business and go elsewhere. What would this look like here? Would one be in the back of an ambulance doing price shopping on a tablet as they are fighting some terrible injury? Perhaps tie in…
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Re: Hospital prices are about to go public in the U.S.
#174Earlier quoted context omitted.
This is one of those nice ideas that has some pretty serious hidden costs. You’d struggle to compare healthcare in the US to other countries, because the quality of healthcare available (talking about availability, not accessibility) in the US is generally superior to other countries. So you could end up simply eroding the quality of care in the US. Another thing people tend not to talk about when discussing healthca…
In my experience, Russia had a decent healthcare system in the Soviet era. Care was (obviously, I guess) pretty much free. Most physicians were female. And most of them were apparently driven by moral conviction. The US was rather a shock for me. Costs were mind-boggling, and most physicians struck me as jerks. At least, the male ones did, and they predominated. Nurses, on the other hand, generally seemed OK. Somehow…
This is anecdotal. To counter, my family have had very good overall experience with physicians in the US. Moreover, my college friends who went on to become physicians are all people I'd happily take my own family to see.
One of the problems with care in the US are clinics that treat Drs (and NPs and PAs) essentially as billing machines, and don't allow them any time to build any rapport or relationship with patients. Depending on your insurance coverage, your location, and your needs, your experience will vary wildly.
Re: Hospital prices are about to go public in the U.S.
#175Presumably, this is based on ICD10 codes... but there can be 30 different services tied to a code. You still won't know what code is being charged until after the service is rendered, and if it's rack rate you won't know the actual rate your insurance will be charged, until THEY tell you... because that is proprietary information (just like the reason why your treatment was denied coverage). Imagine you have diabetes…
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Re: Hospital prices are about to go public in the U.S.
#176I'd be happier to see regulated business practices. While I agree that the prices are a problem, I've felt more pain from bills that keep coming in for more than a year after a major event. And when I go to complain, they say that someone made a mistake, the insurance took a long time to respond, or some other excuse. Give me a final bill with all charges within 30 days, then 30 more days to resolve any issues with that bill, and then let the billing end so we can move on with our financial lives without wondering if one more bill is going to show up next week, tied to my credit record.
Re: Hospital prices are about to go public in the U.S.
#177Earlier quoted context omitted.
I didn’t say research alone did. I said that when you compare investment in research, as well as the quality of care, you’d expect the cost of healthcare in the US to be higher. As much higher as they are? I don’t think so. But if you want to fix the accessibility issues without impacting innovation and quality of care, then you’re going to need a solution slightly more thought out than hamfisted price fixing.
> as well as the quality of care, you’d expect the cost of healthcare in the US to be higher If the quality of care is so amazing I'd expect Americans to have longer life expectancy, and they don't.
As a parent poster noted, the system is optimized to provide amazing care for the people who can afford it ... and those people do have longer life expectancy.
https://www.vox.com/science-and-health/2018/1/9/16860994/lif...
Re: Hospital prices are about to go public in the U.S.
#178Earlier quoted context omitted.
This is one of those nice ideas that has some pretty serious hidden costs. You’d struggle to compare healthcare in the US to other countries, because the quality of healthcare available (talking about availability, not accessibility) in the US is generally superior to other countries. So you could end up simply eroding the quality of care in the US. Another thing people tend not to talk about when discussing healthca…
The Indians have better cardiac surgery outcomes. I don't care about anything but outcomes. It's no surprise, though. Their guy has done 150 surgeries in the last year. This guy has done maybe 40. No good. If things are so much better here, why are outcomes not as good? IMR, MMR, even with companies that have comparable or stronger definitions. The evidence is constantly against US healthcare except for experimental…
At the top end, this will be true. Surely, a well-trained surgeon is a well-trained surgeon and mechanically they should all have roughly equivalent skills. The difference lies in experiential knowledge: knowing what to do whilst in a surgery, based on practical experience and seeing similar patients. We've interviewed four of the top pediatric cardiology centers in the past two months, searching for the best treatment option for our daughter, and only 1 of them has a research focus in the needed area, accompanied by a specific treatment protocol and specifically trained staff. That's not because the other hospitals are "worse". It's a result of our daughter's need being extremely rare, with very low demand. Even the above-mentioned hospital only sees ~1 patient per month (compared to maybe 1 per year or fewer at the other hospitals).
I 100% agree: experience is key ... but so is a clinic's/hospital's internal investment in any given speciality. And if it's a teaching/research hospital, so then is publishing by its clinical experts.
Re: Hospital prices are about to go public in the U.S.
#179Earlier quoted context omitted.
> It's a total mess and hopelessly complex for the average consumer. But not for insurance companies; it's in their interest to compare hospitals and get the best care for the lowest price. I for one hope this will trigger competition. On the other hand, it'll probably end up shafting the personnel instead of the ridiculous profit margins.
The idea of effective competition in emergency services has always struck me as fanciful. The benefit that competition provides to incentivize lower prices and better services is a consumer's ability to easily deny someone their business and go elsewhere. What would this look like here? Would one be in the back of an ambulance doing price shopping on a tablet as they are fighting some terrible injury? Perhaps tie in…
Even if you limit competition among hospitals to non-emergency procedures, it would still be enormously beneficial.
But even with emergency procedures I think you could still have effective competition based on outcomes and price. Here's an article suggesting that in some cases a poor quality hospital will triple your chance of death compared to a good hospital [0]. With more data, I could imagine a study that says, "Hospital B is so much worse for treating heart attacks than Hospital A that it is equivalent to delaying treatment by 20-25 minutes". Paramedics treating a heart attack victim would therefore have a fairly simple calculation: What is the difference between estimated time taken to reach Hospital A and estimated time taken to reach Hospital B? If more than 25 minutes you choose hospital B, if less than 20 minutes you choose Hospital A, and if between 20 and 25 minutes you choose whichever hospital historically charges the least for heart attack treatment.
[0] http://www.nytimes.com/2016/12/14/business/hospitals-death-r...
Re: Hospital prices are about to go public in the U.S.
#180This won't help consumers. The prices (both charges and what Medicare pays) are already effectively public: https://data.cms.gov/Medicare-Physician-Supplier/Medicare-Pr... The problem, as some other comments point out, is that they're way too complicated. The link I posted, for example, is just the provider charges. A hospital visit typically has a facility claim and at least one provider claim. Depending on the type…
> It's a total mess and hopelessly complex for the average consumer. Sounds like something the people on this forum can help improve.
Sounds like something the people on this forum can help improve.
A lot of the problems average consumers face are political/social and not technical (technical problems associated with these issues were solved decades ago). For example, it takes 10 days for my bank to send funds from U.S to my home country. Why 10 days? I have no idea. What I do know is 10 days is extremely unreasonable at the end of 2018.
I filled a form and put "none" for "any visible marks like scars, tattoo etc?" question, because I honestly have none. The form got rejected, now I have to "creatively" answer this question.
When my dad was in the hospital, I got so many bills - I had a lot of trouble looking through those and locating errors (we were charged extra and the only way to find those was to painstakingly go through the bills line by line). I had no energy or interest to do it (when my dad was in the ICU) - every single thing was complex, needlessly so, and was frustrating to the point of tears.
And then comes insurance - ever tried post processing a claim? Wouldn't wish it on my enemy.
There are hundreds and hundreds of examples like these - hospitals, courts/police, banks (even the private ones), airports, any government office in general ... it seems as if they relish in wasting average person's time and money. No amount of software/ML/AI etc can fix these, until the mindset is changed for good.
A large group of people owe their careers and salaries to these inefficiencies, they won't give it up without a serious fight. For example, filing taxes in US - there is no way H&R block, turbo tax etc will go down without a fight, it is just not in their interest to have a simpler tax code.