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Hospitals pledge to fight admin price transparency plan in court

healthcaredive.com

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

#191

Post by AlexandrB »

rhacker wrote: post #31

We have obviously routed out a LOT of fraud by forcing the auto repair industry to change its practices to inspect -> quote -> customer decision. I guess the question becomes this - is there so much fraud in this industry that we need to do this change? Even if it's NOT fraud, have hospitals simply become used to charging anything they want because they have no competition?

The problem is you can't inspect -> quote -> customer decision with someone who's having a heart attack. Even if the person is lucid, they are unlikely to say no to any price if they're at death's door. No amount of competition changes the simple fact that health care is not a fungible service. CPR at facility A can't be exchanged for CPR at facility B if B is even a few minutes away.

Combined with the emotional state most patients are in (something other industries, like mortuaries, prey on as well) and you have a recipe for gouging even under ideal competitive regulations.

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

#192

Post by [deleted] »

Thriptic wrote: post #71
istjohn wrote: post #22

I spent 45 minutes at the hospital where I was to get a lab test done, trying to get a quote for said test. Prescribing doctor didn't know the cost. Lab tech didn't know. Billing department told me I needed a procedure code. Lab tech who was ready to draw blood couldn't tell me the needed code even after spending five minutes at a computer looking for it. Prescribing doctor gave me the code. Called back billing. They…

Lab tests are particularly complicated to price because usually they are being processed by someone else. Usually labs won't even try to get an authorization from insurance until they get your sample and start working on it as it affects their turnaround time which is one of their main differentiators, and each insurer will have different rules about what they will pay for under what conditions (insurers also have se…

[deleted]

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

#193

Post by AtlasBarfed »

wswope wrote: post #159
soneca wrote: post #143

The Econtalk podcast latest episode is about a surgery clinic in Oklahoma that has full price-transparency policy. I am outsider to US healthcare system, but after listening to it, it seems hardly controversial what would be the right thing to do here: https://www.econtalk.org/keith-smith-on-free-market-health-c...

Texas Free Market Surgery offers a near identical business model based out of Austin. Green Imaging (who I used to work for) offers cash-pay imaging services for all modalities across Texas, and are in the process of expanding nationally. Because they contract with existing imaging facilities, they don't post prices publicly to avoid poaching patients, but if you call in or message them through the website, they'll g…

The South is almost a total loss when it comes to medical fraud. Combined with the more unhealthy population, it is just a boondoggle.

There's a reason the Tricare South contract is so coveted.

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

#194

Post by jonlucc »

jimbob45 wrote: post #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 s…

Yeah, if I go to an in-network facility, then they have an out-of-network provider walk into my room, how am I supposed to know? The same is true of labs. My wife had her blood drawn and sent to a lab every couple of years without issue until one year they sent it to a different lab unbeknownst to her. It was out-of-network and cost $800.

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

#195

Post by JustSomeNobody »

rolltiide wrote: post #183
istjohn wrote: post #22

I spent 45 minutes at the hospital where I was to get a lab test done, trying to get a quote for said test. Prescribing doctor didn't know the cost. Lab tech didn't know. Billing department told me I needed a procedure code. Lab tech who was ready to draw blood couldn't tell me the needed code even after spending five minutes at a computer looking for it. Prescribing doctor gave me the code. Called back billing. They…

I just want a way to sue the fuck out of all medical professionals that told me something would be covered by my insurance Getting evidence of these statements is a challenge but a civil court would easily put them on the hook for the cost they said I wouldn't incur and 3x it with punitive damages and then double whammy with a review of their license They'll go ahead and try to argue what "covered" meant, and everyon…

I just want all of my medical needs covered no matter where I go or who I see. The burden of in- or out- network should not be on me especially when ins providers can change each year because the U.S. still thinks you should have to have a job to have insurance that you can afford.

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

#196

Post by TheSoftwareGuy »

triceratops wrote: post #162
mark-r wrote: post #138

Earlier quoted context omitted.

> all the pharma companies would save millions every year. Their savings would never be passed on to the customer. And it's hard to believe there would be any savings overall, because the advertising must be bringing in more money than it costs or they wouldn't be doing it.

I'm not disputing pharma advertising is profitable for individual products. I'm skeptical if it's profitable in aggregate. Drug demand is a function of the occurrence of disease. Advertising can increase profits by: 1. Taking market share away from a competitors. Profitable for that product, zero-sum for the industry. Competitors respond by increasing their ad spend, equilibrium returns (unless one drug is genuinely…

There is a third function I don't think you are considering:

Informing patients that an option is available to treat a particular condition, who might otherwise not go to a doctor.

This would also be a positive for both the market and for patients.

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

#197

Post by AtlasBarfed »

glofish wrote: post #13

This is IMO the "simple solution" to healthcare - nothing will bring down healthcare costs faster than the following - be allowed to choose - know how much something costs - pay some of the cost themselves (co-pay, health savings account) etc.

- you can't choose in emergency care, so the libertarian pipe dream goes out the window when your supply is fixed and your demand is urgent

- cost discovery will be inefficient and time-consuming, which is why single-payer with standard costs is so much more efficient

- who doesn't have copays and out of pocket in the US?

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

#198

Post by nhyun »

bluGill wrote: post #114
legitster wrote: post #8

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.

If you're concerned about hip replacement quality, you should care more about the surgeon than the hospital. Check out the ProPublica Surgeon Scorecard: https://projects.propublica.org/surgeons/

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

#199

Post by AtlasBarfed »

bcrosby95 wrote: post #17
braythwayt wrote: post #9

Here in Canada, there is no price transparency whatsoever. Just when people are facing the stress and uncertainty of fighting a crisis like Cancer, they are given absolutely no inkling what their treatment will cost. When a physician makes an appointment for you with a plastic surgeon to discuss reconstructive surgery... No transparency about the cost. When they prescribe chemotherapy... No transparency about what th…

There are shades of bad. The US health care system with price transparency is better than the US health care system without it. The same procedure can cost 1,000x more if you go across town. It's been long reported that Hospitals mostly pull prices out of their asses. The health care problem in the US is not just a health insurance problem, it is also a health care provider problem. Even if you had a single payer sys…

Like the education system, the health care system's retail price is basically ludicrous.

This is to extract maximum situational revenue, basically get as much from the patient as they can afford.

Colleges charge 100k, but will adapt spending (as little as possible) to get students to be able to pay. They even preferentially let in richer students.

It's the ideal way for a business to make money if they can charge based on how much each individual can pay (and bankruptcy is someone-else's-problem in both healthcare and tuition)

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

#200

Post by bduerst »

ddlatham wrote: post #95
istjohn wrote: post #22

I spent 45 minutes at the hospital where I was to get a lab test done, trying to get a quote for said test. Prescribing doctor didn't know the cost. Lab tech didn't know. Billing department told me I needed a procedure code. Lab tech who was ready to draw blood couldn't tell me the needed code even after spending five minutes at a computer looking for it. Prescribing doctor gave me the code. Called back billing. They…

How does contract law fit in here? If a business performs a service for me and won't tell me ahead of time how much it costs, can it afterward decide I must pay whatever it wants? One trillion dollars? For those without insurance, is there some contract agreed to with the hospital? For those with insurance, in which contract do I end up bound to pay an amount that isn't told me until after I've already made the decis…

Hospital networks usually have you sign a waiver agreeing to pay for all costs before treatment begins. It's a bit strange to be waiting in the ER and a have a billing handler ask you to sign a form on a clipboard before you can get service.
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