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Show HN: Compare prices that US hospitals charge patients, insurance companies

turquoise.health

281–290 of 389 posts

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#281

This is made possible thanks to the current administration’s CMS price transparency rule which went into effect Jan 1,2021 http://www.cms.gov/hospital-price-transparency Edit: By “current” I mean the Trump administration.

Out of curiosity, how much will this reduce the cost of health care? The idea, as it's been explained to me, is that visibility into the cost of medical care will result in downward price pressure. How much?

Personal opinion (as a health economist) is that this is a nice policy, but probably not going to do that much.

You as a consumer now have the ability to search, but do you have an incentive to do so? Do the savings come to you?

Some of it, perhaps. But it's likely not that much and only under some circumstances.

E.g., if you are just faced w/ a copay on a visit, your copay is going to be the same at two facilities.

Coinsurance is different - there you may realize some savings. IF you are below your deductible for the year that is also different. You may realize savings and care.

But there are a decent number of patients who for most of their visits will not see much incentive to search.

Also... it is possible for these releases to help hospitals coordinate on prices in a way which they currently do not. (Tacit collusion, not explicit, back-room, definitely-illegal collusion.)

Hospital A now knows exactly what Hospital B gets from Aetna, so Hospital A may realize it can hold out for more w/ Aetna b/c Aetna is willing to pay their competitor more for the same procedure.

Both of these questions are above all empirical questions and one to which we do not yet know the answer. I would be wary of confident predictions.

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#282

I just read an article about quiet / dream jobs (park ranger etc.) In it, every single person has a side gig(s) or is otherwise making decisions on their careers based on medical coverage. Every one of them! One of the people says most people leave when they turn 26 because they can't stay on their parents' health insurance. What?! > And like other dream jobs I learned about, it’s not enough to survive on: During > o…

// Having the freedom from health care costs is more freedom for more people than the "freedom" to not pay health insurance or taxes to cover it. This is not how freedom works. Your argument is akin to saying "freedom from hearing uncomfortable opinions" benefits more people than "freedom of expression" does. On the broader level, I got to experience healthcare in the US both as a broke-ass immigrant child and as a w…

Would the general public of other developed nations be happier if their healthcare systems were more like the US's?

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#283

Even I am surprised: Appendectomy: MSDRG 343: at Kaiser in Santa Clara: $56,000 Appendectomy: MSDRG 343: at Holston Valley Medical Center, TN: $4,700 Our healthcare system is even more broken than I ever imagined.

Do not draw conclusions from this specific case because Kaiser in particular is very, very different.

You may be able to find similarly insane examples at other hospitals, but Kaiser is vertically integrated: generally Kaiser doctors send Kaiser-insured patients to Kaiser hospitals.

I am not sure how they reach their measure of a "price" here but it is entirely possible it's unusual and or different.

Again you can probably find something similar at non-Kaiser hospitals (Just for fun... check the Sutter system in NorCal - it's extremely expensive), but Kaiser is not the reason you should think this is insane.

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#284

Earlier quoted context omitted.

This is not that plausible as an analysis of the role of chargemasters. I agree that the chargemaster prices are fake, but what you are proposing is: Hospital: "Our insurance partners pay us a fraction x of Chargemaster charge X, so let's make C larger ." The insurer understands the game being played here, just like you do. It's not like the insurer doesn't also realize just like you do that the chargemaster price is…

My understanding is the insurance companies are incented for C to increase as well - under the ACA insurance companies can only have a certain profit margin, so the only way to increase profit is to increase revenue and payouts.

From a personal conversation with an insurance company board member, I’ve been told this isn’t a factor as most aren’t running anywhere close to that line. The bigger factor in his eyes is healthcare providers building local monopolies. I don’t know how true that is, but I wanted to share.

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#285

Earlier quoted context omitted.

- paying for services for people who don't have/can't afford insurance. - medical malpractice insurance -> legal system - big pharma/med devices industry

Don’t forget AMA antitrust violations but curbing the number of doctors that could get into the system.

Underrated answer, but it isn't an anti-trust violation when they have permission to accredit med schools!

To be clear: I totally agree w/ you that the AMA is a cartel.

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#286

It's always fascinating to see that even compared to prices you pay as a self-paying patient in Germany (which are already 1.5x - 2x higher than what the "public" insurances, ie. 85% of the population, pay for the same procedures), the prices in the US are about 5x to 10x higher. The standard of care seems to be quite comparable if you look at outcomes, so there must be huge inefficiences in the American system (doct…

I wonder if the reported prices are the aggregated total price for treatment? Or is it just a price of an individual procedure, excluding whatever else that normally goes into the treatment, like diagnostics, admin and nurse time, room/facilities expense etc?

Generally, every hospital reported price is different. Many of the prices reported are "all in" service packages, but several also wouldn't include these ancillary charges. Forthcoming price transparency legislation puts more pressure on hospitals/insurance cos to quote these "all-in" bundles. On the Turquoise site, we'll be representing all inclusive bundles with a checkmark + explanation that the provider has verified with us the rate is inclusive of all professional/ancillary charges.

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#287
post #8

Why are the prices so insane? Where do the money go? I'm from Eastern Europe so of course the prices would be different, but by an order of a magnitude at the minimum seems strange.

- paying for services for people who don't have/can't afford insurance. - medical malpractice insurance -> legal system - big pharma/med devices industry

Everyone hates pharma (not entirely without reason!) but all drug spending is about 10% (slightly less) of US health care spending.

If you spent $0 on drugs next year, we would not save that much money.

If you want to cut spending, you need to cut spending on doctors and hospitals.

If you want sources for these numbers, here is the National Health Expenditure summary from the Centers for Medicare and Medicaid Studies:

https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#288

A number of people, including me, have been building similar things, see http://price.hospital The problem seems to be figuring out a revenue model, and translating all the medical terms in to human.

Same, I've been mapping out CA average prices at http://hospitalprices-env.eba-r2yhwdcw.us-west-1.elasticbean...

Comparing just the price of a hip replacement is difficult, because there are so many other services that will bundled in with a hip replacement (anesthesia etc) that may not be represented in the service price alone.

The "average cost by diagnosis code a patient comes in with" transparency requirement is an attempt at solving that, but doesn't differentiate between insurance plans.

Also, I love OpenStreetMap, thanks for your work on that!

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#289
post #76

Earlier quoted context omitted.

Look up the salary of your local hospital president. In my medium town of (Pop 200K) they pay him $980k per year. That is an absurd salary for a relatively small hospital!

How do I look that up?

AFAIK, certain non-profits are required to report the salaries of their ten highest paid employees.

Doesn't mean it will be easy to find, but you might be able to find it that way.

But this is not information the hospital would share w/ you w/ great enthusiasm, obviously.

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#290

Earlier quoted context omitted.

I realized over the past few years that there is no "natural" price for anything. It's 100% set by competition. Economic research confirms this. Mergers result in higher prices due to less competition. What we need is way, way, WAY more competition in healthcare. 10x as many providers, 10x as many clinics, with prices posted on the wall. When they start losing business, they'll notice.

There will never be 10x as many providers due to the AMA and lobbying. Existing interests don't want to see lower prices and competition. If this was possible, I'd agree with you. But the reality is that the best we can hope for is single payer.

I was arguing with a doctor friend recently about the AMA. He's on team New York Times, "knows" the Koch brothers are Satan incarnate, "knows" Trump owes Russian oligarchs money, etc.

It just didn't register that the AMA is the sixth-biggest spending organization on DC lobbying [1], right behind Blue Cross Blue Shield (an insurer) and the American Hospital Association.

People worry about the NRA and all kinds of other stuff. They should really get mad about how outrageously the medical industry lobbies (as do the realtors), and how much they've managed to extract from ordinary Americans. It's an utter coup of PR that people aren't rioting in the streets about this. Everything about the medical industry -- licensing, high physician salaries, etc. is rigged to be good for insiders.

[1] https://www.opensecrets.org/federal-lobbying/top-spenders

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