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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

#231

Post by whb07 »

jakobegger wrote: post #178
whb07 wrote: post #154

Earlier quoted context omitted.

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 mon…

First of all, the idea of a “wait list” is terrible in and of itself. That’s called rationing. And it’s only “okay” for now assuming the public finances don’t deteriorate. Anecdotally you’re not the first person from a rationed system to mention long wait lines.

Second, I believe Austria has great care and smart surgeons etc. But again there’s a vast difference between “good” and “outstanding/ first in class”. I’m not cheerleading the current US system, I think it’s terrible that it’s a monstrosity that leans more socialist than free market and everyone gets the worst of both worlds.

But seriously, let’s not argue where most medical innovation and drug breakthroughs come from. Before everyone goes into a rage, I’m not saying all innovation, but most. Kinda like there are tech hubs around the world but right now the center of gravitas is mostly SF.

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

#232

Post by mrguyorama »

carapace wrote: post #167
braythwayt wrote: post #36

Earlier quoted context omitted.

What you say is true, but does not negate or discount what I said in any way. Again, with the XY problem... If someone asks for X, but really needs Y and there is a better way to get Y than to help them with X... Of course X is better than no X and no Y. But that doesn't change the fact that Y is much, much better than X. And in the case of health care, it is not even close. Price transparency may lead to each person…

I think you're right (profit motive and health care don't mix) but then how do you cut the Gordian Knot? I'm cautiously hopeful that price transparency might be a start.

Honestly? Stop electing people who scream that public health is a communist devil plot?

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

#233

Post by bduerst »

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…

I worked in lab EHR software and can say this is the correct answer. Lab pricing is particularly complex and is not like buying a hammer or a pedicure.

There was a separate billing module that calculated pricing for individual procedures based on a number of factors, such as insurance provider, diagnosis codes, performing lab, urgency, etc. along with a whole set of separate rules for medicare/medicaid patients. Even the timing of drawing blood (relative to other procedures) was factored in for insurers.

Transparency isn't going to help much here when the problem is the complexity created by multiple payers.

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

#234

Post by triceratops »

jonlucc wrote: post #185
triceratops wrote: post #162

Earlier quoted context omitted.

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 are two niches in which your analysis is incomplete. First, There are underdiagnosed diseases for which patients don't seek care, sometimes because they do not believe there to be a treatment. The lack of treatment means that it isn't as vital for physicians or patients to pursue diagnosis. Those patients might see an ad and return to a physician to ask if that treatment is a fit. Second, not all physicians are…

> not all physicians are as on top of new treatment options as we expect.

I thought this was called pharma marketing. I don't think this should be abolished - I only meant direct-to-consumer advertising. Although I've seen someone else argue that doctors should be required to undergo continuing education instead.

I'd like to see numbers on how often an ad is how the patient learns they have a disease. I imagine that anyone with really annoying or debilitating symptoms would research them online from time to time.

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

#235

Post by bduerst »

stefan_ wrote: post #121
Thriptic wrote: post #71

Earlier quoted context omitted.

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…

None of this has anything to do with lab tests, which are an absurdly routine procedure. It's entirely divorced from the subject matter. It's not "complicated" out of necessity, but for profit.

Routine != Simple

Frequency and complexity are not mutually exclusive. The pricing structure reflects the diverse system of payers (insurance companies) and has time-based complexity (i.e. bundling) that prevents payment cost structure from being calculated up front.

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

#236

Post by programmertote »

AtlasBarfed wrote: post #189
programmertote wrote: post #140

Earlier quoted context omitted.

Exactly the way it works in a SE Asian country I grew up. The private and public hospitals have price quotes on different procedures and it's for everyone to see. The comments above using Boglehead's quote as a justification of why medical pricing has a lot of variance is mostly a lie. My wife, who is a doctor trained in our home (SE Asian) country and is doing her residency in the US, and I were just laughing at the…

Have you seen radiologist salaries? It's a scam, Jim. There are four pigs at the trough of US health care: Insurance Device/Drug Lawyers Doctors Everyone points the finger at other people and desperately fight to maintain their bloated share of the bloating pie. Unfortunately doctors are not your friends in hospitals. They are trying to get billing.

Indeed! As she was applying for residency programs, my wife briefly entertained the thought of becoming a radiologist because boy, they made a load of money for 8am-2pm work! We both are 100% self-aware that healthcare industry has a lot of bad actors including doctors, pharma companies, hospital admins, lawyers and pretty much everyone involved.

If residents cry about 60+ hours/week of work during the first year residency, I don't pity them much. First of all, the hours aren't really that bad even for a hospital in metro NY area (speaking from my wife's residency experience so far). In our home country, residents have it worse; my wife had night float EVERY THREE DAYS over there. In the US, it's at most four times a month! Second of all, the "grueling hours" are for the first year of residency (in fact, during those hours, there's not much happening especially in night floats, so you can get decent sleep) and after that, things got much, much better. Sacrificing just one year and paying exorbitant exam/school fees--in the region of ~$250K total--to make $250K as starting salary is TOTALLY WORTH it. If any of the doctors complain that they are debt-laden, they are either fiscally irresponsible or are simply exaggerating. They can repay $250K debt + interest in less than 5 years if they really want to. Of course, it's much easier to use these (debt and hours/years sacrificed) as excuses to justify their pay.

If the doctors are true and honest, they should be advocating AMA to relax the residency and medical school requirements. No more than five years total (no undergrad necessary) is needed to treat garden variety problems. Then each specialty/fellowship can take however long it needs to take. But AMA and its leechers (KAPLAN, ECFMG, USMLE, FSMB, etc.) won't allow that because they make loads of money from exam and preparation fees. Everything about healthcare is business now and whether it is good or bad depends on one's moral compass (and how strongly one feels about capitalism).

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

#237

Post by AnimalMuppet »

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.

I think a bit more is needed.

Let's say it's 1990, and I'm in the market for a car. A Yugo costs a lot less than some other cars. But I'm getting a lot less for it, too - it's less reliable, won't last as long, and is less comfortable. But, as a car buyer, I can kind of tell that. It doesn't feel like it's as solid a car as some of the other options.

Now say I'm trying to have a hip replacement. Here's a place that costs 20% less than the other place. Sounds great, but... what are their rates of complications. How about if you go out 20 years? Without that kind of information, I can't compare on price, because I don't know whether I'm buying equivalent things.

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

#238

Post by AnimalMuppet »

jonlucc wrote: post #194
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.

I've had good luck arguing with the insurance company on that kind of thing. It's worth a phone call.

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

#239

Post by distances »

nix0n wrote: post #156
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…

One of the things you sign when you visit a doctor or hospital says that you'll pay whatever insurance doesn't cover. I've seen maybe 10 versions of this and none list any limits. If you were charged $1T you might be able to challenge it in court. If you simply don't pay, the bill collectors will start harassing you, and your credit score will suffer. I'm not sure at what stage they are allowed to take your wages etc…

Going a bit off topic, but this is one difference many are perhaps not aware: personal bankruptcy isn't a thing in many European countries. In my home country you don't have a mechanism for simply shedding your debt. Generally any debt is garnishable. Your best hope is debt restructuring with part of the debt forgiven (in perhaps 10 years).

On one hand this probably makes financing considerably cheaper as the risk for the bank is quite a bit lower. On the other hand you do not want to have personal liabilities anywhere near a risky venture.

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

#240

Post by mc32 »

sigstoat wrote: post #170
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.

> It is only emergency rooms where I don't get a choice - if you need an emergency room close is important. i feel like the folks on here peddling this line have not ever spent any time watching who comes through an ER. most of the people who go into an ER aren't dying, or screaming in pain. they've just got a problem that can't wait until urgent care opens up again in the morning. or they need something done that ur…

I think lots of people say “ER” for trauma center.
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