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Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

healthcaredive.com

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Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#21

Post by MarkSweep »

scheme271 wrote: post #5

This will probably help a bit but in an emergency people don't have the time to compare prices. And with US health care, it just takes one accident that sends you to the ER and where someone that's out of network performed a procedure to end up with a bill that's tens or hundreds of thousands of dollars.

There is a little bit of good news here from the omnibuss budget passed at the end of 2020. Search for “NO SURPRISES ACT” on this page:

https://congressionaldish.com/cd227-coronabus-health-care/

“Starting on January 1, 2022, any health insurance company that provides “any benefits” in an emergency department can not require pre-authorization of those services or deny coverage because the emergency department is out of their network. If emergency services are provided out-of-network, there can not be any limits on coverage any more restrictive than what would be covered by an in-network emergency department and the out-of-pocket costs can’t be more than they would be in-network. Out-of-pocket payments at an out-of-network emergency room must count towards in-network deductibles and out-of-pocket maximums.”

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#22

Post by toast0 »

breckenedge wrote: post #6
spaetzleesser wrote: post #2

Full openness is a good first step to make this insane system a little better. Next step would be for hospitals to quote the same price for the same procedure no matter if or where you are insured. I can’t think of another business where prices are different by hundreds of percent for different customer groups. Also get rid of the whole in and out network system.

I like the idea of getting rid of in/out of network. Both recent administrations have taken steps in this direction.

Networks are a double edged sword. They're a pain to use (especially for things where network facilities have non-network providers or network providers steer you towards non-network accessory care like labs and what not), but network agreements are also a way that insurers control costs. Forcing insurers to cover every provider means insurers can't exclude overpriced providers.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#23

Post by nradov »

peterangular wrote: post #7
dpayonk wrote: post #3

There is obviously a ways to go to create a system where price transparency is feasible, but I’m very interested in how the community might think it would affect the value based healthcare industry with respect to total cost of care management and bundled services? You cannot always look at a service in isolation because of complications on episodes like joint replacements or the impact of chronic conditions over the…

> You cannot always look at a service in isolation But in the American system it's setup that you must. This is the whole "coding" thing that you hear people refer to which is taking a procedure and breaking it into individual codes that can be used in billing you/your insurance. This was addressed in the "Methodology" section of the article: > Data was collected for three services, determined by specific codes. ---…

The US healthcare system is slowly moving away from the fee-for-service model and towards a value-based care model. Under that model, providers bear much of the financial risk. They might receive a single bundled payment for a joint replacement including all follow-up care, with penalties for failing to meet clinical quality measures. Or they might receive a flat per-patient per-month fee to completely care for people.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#24

Post by missedthecue »

scheme271 wrote: post #5

This will probably help a bit but in an emergency people don't have the time to compare prices. And with US health care, it just takes one accident that sends you to the ER and where someone that's out of network performed a procedure to end up with a bill that's tens or hundreds of thousands of dollars.

Emergency care accounts for just 2% of healthcare spending.

https://www.politifact.com/factchecks/2013/oct/28/nick-gille...

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#25

Post by ed25519FUUU »

Someone1234 wrote: post #10

Local hospital released this as an Excel spreadsheet (Chargemaster). They have a column called "Uninsured cash price." These prices are And, no, I don't think this was by accident as they have updated this Excel spreadsheet several times and only that one column is always set to 0 size.

I would think hospitals like people paying the cash price?

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#26

Post by leetcrew »

dpayonk wrote: post #3

There is obviously a ways to go to create a system where price transparency is feasible, but I’m very interested in how the community might think it would affect the value based healthcare industry with respect to total cost of care management and bundled services? You cannot always look at a service in isolation because of complications on episodes like joint replacements or the impact of chronic conditions over the…

sure. any given procedure has a happy path and many different ways it could go wrong and become much more expensive. you can't really predict what it will cost for an individual. but after performing the same procedure hundreds or thousands of times, the hospital ought to be able to figure out a standard rate that (statistically) covers its costs. I don't see a good reason why a large organization with tons of cashflow shouldn't be able to quote a price up front after taking any pre-existing conditions into account.

of course, we might not like the prices they quote if forced to do this, but it would at least be better than rolling the dice every time.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#27

Post by toomuchtodo »

Someone1234 wrote: post #20
toomuchtodo wrote: post #14

Earlier quoted context omitted.

File a complaint with Health and Human Services [1]. It is clear they are not acting in good faith. Take snapshots of the URL with the Internet Archive for notarization [2]. [1] https://www.cms.gov/hospital-price-transparency/contact-us [2] https://web.archive.org/save

I actually might, the wording on this page: https://www.cms.gov/hospital-price-transparency Does say "provide clear, accessible pricing information" which I would argue this is not. edit: Filed a complaint.

I genuinely appreciate that you took the time to do so.

EDIT: Thank you all for your efforts.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#28

Post by Someone1234 »

ed25519FUUU wrote: post #25
Someone1234 wrote: post #10

Local hospital released this as an Excel spreadsheet (Chargemaster). They have a column called "Uninsured cash price." These prices are And, no, I don't think this was by accident as they have updated this Excel spreadsheet several times and only that one column is always set to 0 size.

I would think hospitals like people paying the cash price?

They make less that way. If they know you're insured they won't allow you to pay the cash price, only the much higher negotiated price.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#29

Post by mistrial9 »

arcticbull wrote: post #19
hanniabu wrote: post #8

Earlier quoted context omitted.

The whole out of network aspect in hospitals is ridiculous

Yes, in a single-payer environment everyone is in-network. Every doctor in Canada providing covered medical services is in-network.

I was told by a cancer patient in the US, who is a Canadian citizen, that specialized equipment and certain tests are not available in the entire system, or months-long wait times.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#30

Post by aqme28 »

spaetzleesser wrote: post #2

Full openness is a good first step to make this insane system a little better. Next step would be for hospitals to quote the same price for the same procedure no matter if or where you are insured. I can’t think of another business where prices are different by hundreds of percent for different customer groups. Also get rid of the whole in and out network system.

Completely agree with your point, but I want to point out that a lot of businesses (most?) adjust pricing based on the consumer group.
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