Hospitals lift curtain on prices, revealing giant swings in pricing by procedure • Hacker News Board

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

#51

Post by pkaye » Wed, Sep 22, 2021, 5:13 PM UTC

samstave wrote: post #4

When I was working in healthcare, I found out that hospital groups negotiate their own Code prices with each carrier individually. So one group will have one rate with Blue Shield vs what another hospital will have. Its absolute bullshit. --- If youre mandated to have insurance - then procedures should be regulated to a set cost regardless of who performs the procedure.

Another thing is Medicaid pays below the cost of care so that is balanced by the private insurers payments. This is why you see many county and rural hospitals struggling because the private hospitals have taken the cream of the crop private insurers. First step is the make sure hospitals are not drowning in covering for costs of Medicaid and uninsured patient care.

This Frontline documentary talks about this issue.

https://www.youtube.com/watch?v=UVvEkeH4O8o

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

#52

Post by LurkingPenguin » Wed, Sep 22, 2021, 5:14 PM UTC

novok wrote: post #38

breckenedge wrote: post #6

Earlier quoted context omitted.

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

Psychologists want to charge $200-$250/hr, but insurance only reimburses $120-$160/hr. You might think these are high prices, but chargeable hours isn't hours worked for psychologists, since they have to do notes for every meeting, manage the business, appointments, etc, which reduces their total take home to something below $200k/yr, which is below a typical bigtech Eng II with only a couple years of experience, pot…

> You might think these are high prices, but chargeable hours isn't hours worked for psychologists, since they have to do notes for every meeting, manage the business, appointments, etc, which reduces their total take home to something below $200k/yr, which is below a typical bigtech Eng II with only a couple years of experience, potentially not even going to college if they are clever and self motivated enough.

Silicon Valley/big tech is not the center of the universe. How is what "typical" engineers at big tech companies make relevant to a discussion of what psychologists and other medical professionals make? Are you suggesting that the medical profession is doing battle with big tech for (future) workers?

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

#53

Post by peterangular » Wed, Sep 22, 2021, 5:14 PM UTC

nradov wrote: post #23

peterangular wrote: post #7

Earlier quoted context omitted.

> 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 peopl…

Good faith - not trying to be a bastard...

I've heard rumblings of this too but every time I've interacted with healthcare it's still the same coded system that you see in regards to the chargemasters etc... even as recent as-of a few weeks ago this was the system in a modern hospital in a large west coast city.

So, two things:

1. I think we're on the coded system indefinitely, or at least that's only what I can expect given recent experience

2. Even if we were to implement this, providers and insurers will still fight like cats and dogs because there's just too much money to be made here that I can't imagine the same problems won't manifest itself in a "bundled payment" system. I would actually expect this to make matters worse. Often when you bundle something it obfuscates and confuses the value of the individual "things" in the bundle - the middlemen will do everything they can to extract margin from this. I'd personally like to stay with codes to maintain transparency through having an auditable receipt of known services directly tied to a fair price.

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

#54

Post by 5faulker » Wed, Sep 22, 2021, 5:17 PM UTC

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.

It's like that "display:none;" thing in CSS.

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

#55

Post by vmception » Wed, Sep 22, 2021, 5:18 PM UTC

Great, now mandate that it is viewable via API

Can even use the healthcare industry standard for EHR which is JSON and RESTful

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

#56

Post by vmception » Wed, Sep 22, 2021, 5:19 PM UTC

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.

Its just the first step

To shock and awe into future laws

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

#57

Post by marcellus23 » Wed, Sep 22, 2021, 5:20 PM UTC

kindle-dev wrote: post #34

Someone1234 wrote: post #28

Earlier quoted context omitted.

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.

But someone told me insurance companies are bad and are stiffing those poor, struggling doctors and hospitals.

Just because hospitals are also evil doesn't mean insurance companies are not.

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

#58

Post by avs733 » Wed, Sep 22, 2021, 5:21 PM UTC

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.

You inspired me to look at the local hospital we just delivered our first child at.

They release 'standard charges' which as far as I can tell means 'the range of charges for this particular diagnosis based on past data' as an excel file.

But the price list is a text file delimited by pipes (vertical bars... |) which just seems unnecessary. They also do nothing to define the variables or column names they use...so that's nice.

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

#59

Post by mabub24 » Wed, Sep 22, 2021, 5:21 PM UTC

peterangular wrote: post #35

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.

And this can really cause issues for people who are insured because if an insurance company decides not to cover something (very very common, even in-network) then the inflated price is what you end up getting billed for. That is until you call the hospital and find out there's all sorts of "sliding" prices etc... I had a procedure billed for one of these drastically larger "insured" codes which got denied based on t…

> Best insurance here is "don't get sick"

Recent New Yorker article looking at the "Costa Rica model"[0] raised this point as well. America, by contrast to Costa Rica, has a very weak public health sector and infrastructure, and this leads to a real weakness when focusing on preventable illnesses and issues.

[0]: https://www.newyorker.com/magazine/2021/08/30/costa-ricans-l...

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

#60

Post by peterangular » Wed, Sep 22, 2021, 5:22 PM UTC

throwaway0a5e wrote: post #50

peterangular wrote: post #35

Earlier quoted context omitted.

And this can really cause issues for people who are insured because if an insurance company decides not to cover something (very very common, even in-network) then the inflated price is what you end up getting billed for. That is until you call the hospital and find out there's all sorts of "sliding" prices etc... I had a procedure billed for one of these drastically larger "insured" codes which got denied based on t…

There's police around hospitals constantly and if they get a whiff that you have a fake ID they're going to be talking to law enforcement sooner or later.

Also this isn't going down to your corner liquor store and flashing your drivers license... that thing is going to get scanned etc.

---

Actual protip: If you're uninsured and need care they legally can't turn you away at an ER. They have to provide the healthcare to get you stabilized regardless if they're going to be able to bill for it or not... which ironically this is a big part of why the insured end up subsidizing the uninsured at the hospital.

Also, if this ends up being you - don't sign anything until you're in the right mind to sign something. They're going to try to pin you to bill your ass off one way or another and if you're half way through a heart attack or something do not sign anything until you can 100% understand what you're legally agreeing to.