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Hospitals pledge to fight admin price transparency plan in court

healthcaredive.com

171–180 of 311 posts

Re: Hospitals pledge to fight admin price transparency plan in court

#171
The most salient issue is insurance providers being able to proclaim arbitrary hospitals as "in-network" and "out-of-network". My significant other claims that hospitals are now hiring contractors, who are always by definition "out-of-network". This hurts the career prospects of the contractor and lowers the level of care received.

And for nothing! Insurance should not be certifying which doctors you can and cannot see. That's for the medical boards to decide.

Re: Hospitals pledge to fight admin price transparency plan in court

#172

Earlier quoted context omitted.

Sure, this is the reason why you can't get an answer but it's not a justification . There are 2 parts to it. The first, which is reasonable, is that a lot of treatments are bespoke. Fine. That's a justification for their being costly not for your having to imagine the cost because no one can tell you. Even for flights, the truth is I can get a bespoke flight if I can afford it. And if I want to know how much it is th…

> The first, which is reasonable, is that a lot of treatments are bespoke. Fine. That's a justification for their being costly not for your having to imagine the cost because no one can tell you. Treatments are billed using billing codes so they are definitely not bespoke.

Those billing codes are CRAZY complex tho. One example: when you see a doctor you may generate multiple billing events. For instance they may draw blood, take an X-Ray, and perform a specific type of test.

In a sane world you would generate three billing codes, sum them, and you'd have your price. But that's not how it really works. Instead certain billing codes can be combined to form new billing codes which makes things stupid crazy hard to reason about.

Those rolled up billing codes can then even roll up to different billing codes when combined with other procedures or other grouped billing codes.

When billing is this complex the treatments do begin to look relatively bespoke.

Basically we're inefficient from basically every direction in the USA. Because every player in the system negotiates with basically everyone else individually you end up with a nightmare of complexity and all of the associated insanity. Hospitals love it because it means that they can take advantage of the complexity to bill for all sorts of things that they otherwise couldn't simply because no one can audit this stuff effectively.

Re: Hospitals pledge to fight admin price transparency plan in court

#173
The problem with transparency at the hospital level is the CPT coding system, for which all medical entities including the govt pay the AMA millions of dollars to use, which splits up exams and procedures into components. So even though the knee MRI might cost $1600 (ridiculous but typical), that does not include the radiologist's interp, billed separately by the rad group, or the $300 orbit xray to screen for metal. Also anesthesia is paid based on time, cannot predict that. It is all a sham. And, they can get out of it for a $300 a day fine....well worth it to most of them.

Re: Hospitals pledge to fight admin price transparency plan in court

#174

> Transparency is not going to work where there is no competition, Emily Gee, a health economist at the left-leaning Center for American Progress, told Healthcare Dive. That's bs. I will drive to a further away hospital if it saves me $75 an hour of time spent... (edit: clearly I'm talking about non-emergency here)

We've seen massive consolidation of health groups over the last 20 years. I believe that's the point Ms. Gee is making. There used to be competition 10 or 20 minutes away. Now it's entirely plausible you'll be driving for hours to find a different medical group with similar services available.

In my area (250k people, Iowa) there are 2 health groups.

I actively tried finding a PCP who wasn't part of the two health groups but accepted insurance - as mega health groups greatly increase the total cost of care. I gave up after looking up about 20 from the hundred or so names insurance sent me. Basically everyone

Unity Point recently announced it wouldn't be merging with Sanford health group. That would have expanded Sanford's strong footing in northwest Iowa, gaining 5 hospitals in Des Moines and at least one hospital in most locally large cities across the east half of state.

It's hard enough to make the math work for hospitals in rural areas. The merger would have made it more difficult for the entire region to find competition.

Re: Hospitals pledge to fight admin price transparency plan in court

#175

Earlier quoted context omitted.

Sure, this is the reason why you can't get an answer but it's not a justification . There are 2 parts to it. The first, which is reasonable, is that a lot of treatments are bespoke. Fine. That's a justification for their being costly not for your having to imagine the cost because no one can tell you. Even for flights, the truth is I can get a bespoke flight if I can afford it. And if I want to know how much it is th…

> The first, which is reasonable, is that a lot of treatments are bespoke. Fine. That's a justification for their being costly not for your having to imagine the cost because no one can tell you. Treatments are billed using billing codes so they are definitely not bespoke.

CPT codes are ... complex. They also aren't the only thing billed for (just the simplest to do). Also what you bill and what you get paid are not the same thing. And they payers do not pay the same thing for the same bill.

Re: Hospitals pledge to fight admin price transparency plan in court

#177

The previous administration had a similar effort that failed. I hope that this effort is successful. >"For instance, it could allow one provider to follow and match the prices of the other provider (like two gas stations across the street from one another who face no other competition)," Garmon said. I understand this argument, but I think they underrate how much people are willing to shop around when they actually h…

>I understand this argument, but I think they underrate how much people are willing to shop around when they actually have prices to use as a metric.

If prices are transparent enough, eventually bored programmers will create websites & other tools that make it super simple to find the lowest cost provider in any non-emergency situation, and probably even emergency situations if you are looking ahead of time

Re: Hospitals pledge to fight admin price transparency plan in court

#178
post #154

Earlier quoted context omitted.

Or, you could do what other developed countries do: Don't rely on private for profit hospitals. Here, most hospitals are run either by cities or counties, or by the public insurance companies themselves. This ensures that hospitals have an incentive to be efficient. There are private hospitals, but only very few people go there, since they are very expensive, and you get good care in the public hospitals.

So a quick way to check reality is by looking at behavior, so say you wanted the "best" care for something no matter the costs. Most people would fly to the U.S from wherever. That is telling you something. I agree the "general" care like broken bones etc its probably all the same, but healthcare innovation is done in the U.S. So it is kind of moot to say "its good here"... yes after the innovation trickles its way o…

I have never heard of anybody fly from Austria to the US because the medical care here wasn't good enough, or because some procedure was not available.

I've only heard of people travel to get dental work done cheaper (not to the US).

The only complaint I've heard is that some procedures (eg. joint replacements) have a waiting list, so if a doctor decides that you don't need it urgently, you may have to wait a few months. I don't know what the situation for these procedures is like in the US.

Just because it's publicly funded doesn't mean it's bad quality. It just means there's no incentive to charge ridiculous amounts for procedures.

Also, Doctors still earn a decent salary here. Maybe not comparable to US salaries in absolute numbers, but it's enough to live a very comfortable life, and they don't have any students loans to pay back...

Re: Hospitals pledge to fight admin price transparency plan in court

#179

The previous administration had a similar effort that failed. I hope that this effort is successful. >"For instance, it could allow one provider to follow and match the prices of the other provider (like two gas stations across the street from one another who face no other competition)," Garmon said. I understand this argument, but I think they underrate how much people are willing to shop around when they actually h…

I'd pay more for quality. If I knew hospital X is better at hip replacement I'd pay extra to go there. Of course how much extra I'm not sure, and I'm also not sure how you compare hip replacement quality like that. It is only emergency rooms where I don't get a choice - if you need an emergency room close is important.

There are lots of ways to measure outcomes. First, you can look at institutional metrics like nosocomial infection rates. Second, you can look at metrics for that procedure like rate of surgery revision. Many of these kinds of metrics exist, but are never exposed to the public.
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