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Hospitals pledge to fight admin price transparency plan in court

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

#201

Post by matheusmoreira »

prklmn wrote: post #190
bluGill wrote: post #114

Earlier quoted context omitted.

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.

You compare hip replacement quality by asking what the center's/surgeons complication rate is. How many are they having to go back and redo, a revision as they call it. It would be nice if these rates were publicly accessible in a easy to search database. As it stands now, hospitals market themselves on size, volume, and fancy buildings all of which don't mean much compared to complication rates.

> It would be nice if these rates were publicly accessible in a easy to search database.

That will make surgeons avoid complicated cases due to the risk of failure and its consequences for their careers.

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

#202

Post by ejanus »

Berobero wrote: post #98
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 was in Japan two years ago; got pneumonia and needed antibiotics. Went to a hospital with no insurance and no appointment. I was being seen by a doctor within 30 minutes. Doctor wanted to do some additional labs just to rule other things out, but he was worried that it would be expensive for me given the lack of insurance. He called up billing with me still in the room and had a price within a couple minutes: ~$70…

This is great. We in Third World nations can afford this .

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

#203

Post by ddlatham »

bduerst wrote: post #200
ddlatham wrote: post #95

Earlier quoted context omitted.

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.

Regardless of what the cost is? What prevents them from charging you 2x or 10x or 100x more after the fact?

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

#204

Post by adventured »

CraigJPerry wrote: post #141
Berobero wrote: post #98

Earlier quoted context omitted.

I was in Japan two years ago; got pneumonia and needed antibiotics. Went to a hospital with no insurance and no appointment. I was being seen by a doctor within 30 minutes. Doctor wanted to do some additional labs just to rule other things out, but he was worried that it would be expensive for me given the lack of insurance. He called up billing with me still in the room and had a price within a couple minutes: ~$70…

Japan's system is interesting. Perhaps one of the most successful in the world. Their life expectancy has gone up which obviously means the amount of care to be provided goes up. Costs haven't followed suit and the other side of the equation - outcomes, has also gotten better (comparing against 1990 since that's the first result set i can see attributed to the MHLW in JP) The challenges of their economy are well know…

> Their life expectancy has gone up which obviously means the amount of care to be provided goes up. Costs haven't followed suit

While their healthcare costs are much lower than eg the US, Japan is currently in the middle of a healthcare cost crisis in fact:

"annual health-care expenditure grew at a pace 40 times faster than the economy from 2000 to 2016." [2]

Their healthcare expenditures have more than doubled in the last ~27 years, while their economy hasn't expanded and their population hasn't expanded. While I don't consider a 100% increase over 27 years to be extremely alarming, especially in the healthcare field, it's a substantial increase given the context that Japan is dealing with (budget buried in debt costs, declining standard of living due to debasing of the Yen due to debt, aging population, zero population growth, net negative economic expansion over 25-30 years).

While the US has the ability to cut a lot of unnecessary fat in healthcare to bring down costs, I don't see how Japan is going to be able to do that without harming care (as their system is already well run). The US also has had dramatic economic growth during the time in which Japan has had none, including adding an economy the size of Japan to itself in just the last six years.

Nippon.com, Oct 2019: "Growing Medical Woes: Japan’s Healthcare Expenditures Rise to Record ¥42.6 Trillion"

[0] https://www.nippon.com/en/japan-data/h00561/growing-medical-...

Bloomberg, May 2018: "Japan Seeks Private Sector's Help With Blowout Health Costs"

"Faced with an aging crisis that’s projected to push up heath-care spending by more than 50 percent in the decade through 2025, the economy ministry is leading efforts for local governments to draw on the expertise of private companies."

[1] https://outline.com/59VNKA

Bloomberg, Dec 2018: "World’s longest-living citizens are causing medical costs to soar."

[2] http://archive.is/OxW7n

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

#205

Post by digikata »

Berobero wrote: post #98
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 was in Japan two years ago; got pneumonia and needed antibiotics. Went to a hospital with no insurance and no appointment. I was being seen by a doctor within 30 minutes. Doctor wanted to do some additional labs just to rule other things out, but he was worried that it would be expensive for me given the lack of insurance. He called up billing with me still in the room and had a price within a couple minutes: ~$70…

Prices for care in Japan are basically systematically set by government committees.

https://en.wikipedia.org/wiki/Health_care_system_in_Japan

In contrast, in the US, there are 16 non-medical, mostly billing personnel per doctor.

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

#206

Post by shantly »

noelsusman wrote: post #74
XG6 wrote: post #14

Of course doctors and hospitals don't want price transparency. That would create pricing competition, which would drive down consumer prices, lower profit margins, and force them to become more efficient. Price transparency is one of the key elements of the highly successful Singapore healthcare system. Add in universal tax-free (or tax-deferred) Health Savings Accounts, and we could not only improve the US healthcar…

In Singapore, the government forces you to deposit a percentage of your income into an HSA, and then they tell you what you can and cannot spend that money on. You're only allowed to use that money to buy government-approved drugs, for example, and it's not like the FDA where they're just testing for effectiveness and safety. Also, most hospitals are owned by the government, most doctors are government employees, and…

I'm not aware of a single advanced-economy state (I usually shorthand this "OECD" but Singapore's not a member, AFAIK) that doesn't use price controls, explicitly or de facto (monopsony), in their health care system.

Price controls, non-profit status requirement for insurers, and a non-ruinously-expensive "public option" seem to be common factors in the most "free market" (relatively speaking) systems of our peer states. Despite Obamacare we've achieved zero of those, nor have we opted to go further "left" to mimic any other proven-to-control-costs-and-deliver-care system.

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

#207

Post by tptacek »

digikata wrote: post #205
Berobero wrote: post #98

Earlier quoted context omitted.

I was in Japan two years ago; got pneumonia and needed antibiotics. Went to a hospital with no insurance and no appointment. I was being seen by a doctor within 30 minutes. Doctor wanted to do some additional labs just to rule other things out, but he was worried that it would be expensive for me given the lack of insurance. He called up billing with me still in the room and had a price within a couple minutes: ~$70…

Prices for care in Japan are basically systematically set by government committees. https://en.wikipedia.org/wiki/Health_care_system_in_Japan In contrast, in the US, there are 16 non-medical, mostly billing personnel per doctor.

Where does that figure come from?

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

#208

Post by burfog »

tzs wrote: post #92
egdod wrote: post #11

This is one thing Trump is doing that should get broad support. It probably won’t though, because some people are physically incapable of agreeing with him.

One issue is that while posting standard prices is good, most analysis I've seen says that it won't actually have much effect for most people. If it is done as part of a broad effort to address health care costs and availability, then it's fine. But so far there is no sign of any such broad plan, which leads many to worry that this will be all that the current Administration is going to do to try to lower health cost…

It is done as part of a broad effort to address health care costs and availability. You haven't seen any sign of this because anything favorable to Trump gets very little news coverage. For example, I managed to find one online mention in mainstream news (not sure if it was ever broadcast) that mentions Trump's effort for drug price transparency:

https://www.cbsnews.com/news/pharma-companies-must-reveal-dr...

There is a bunch more that doesn't seem to be in the news at all:

https://www.whitehouse.gov/briefings-statements/president-do...

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

#209

Post by zebrafish »

XG6 wrote: post #164
commandlinefan wrote: post #99

Earlier quoted context omitted.

> doctors and hospitals don't want price transparency Well, I do want price transparency - IF it works the way they promise. It’s hard for me, as a programmer, not to draw parallels to every employer’s expectation that I should be able to listen to them describe a software problem and quote them a timeframe on the spot (which, of course, they’ll then try to “negotiate” down). On the one hand, as a non-medical-profess…

> parallels to every employer’s expectation that I should be able to listen to them describe a software problem and quote them a timeframe on the spot I don't agree with that parallel. It would be like a patient asking, "How much to cure my cancer?" Total cost will of course differ for each patient, but the doctor should be able to tell me the exact cost for a 20 minute office visit or a single session chemotherapy.…

Agreed. Procedures are like products. From a hospital administrator's perspective, you should have a good idea of your cost of goods sold for standard procedures. Lipid panel costs $X in materials (needles, vials, bandages), $Y in cost of the siemens equipment that does the test, $Z in labor cost to draw the blood, etc.

If the administrator knows the COGS for each procedure, test, minute per consult per professional, etc. then quoting and billing should be much simpler than any type of hourly based quote work.

The only time there would be a parallel would be if some doctor deliberated on a diagnosis for a long time. Most of the time though it's a quick collection of symptoms and then diagnosis or trial and error based on those symptoms. Maybe in some surgeries that have more complications than usual I could see a parallel to hourly work.

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

#210

Post by marklabedz »

KukicAdnan wrote: post #88
swebs wrote: post #25

Earlier quoted context omitted.

Crazy, that's the price you would have paid at Minute Clinic without insurance. https://www.cvs.com/minuteclinic/services/price-lists

Yep. I don't mind paying the $116, but the disparity in pricing is so ridiculous. It's like throwing darts at a board and saying "Pay us this much"

Which is why my first response to almost any medical invoice, is "Would you take ["total"]*0.5 to settle the bill?"
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