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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

#61

Post by EvanAnderson »

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…

> 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...

Is there any reason why this kind of windfall shouldn't be illegal? I realize it isn't, but is sure seems like it should be.

I was stuck with a charge from a doctor for 7x the price my insurance would have paid. My pre-ACA insurance refused to cover the procedure and I ended up on the hook for the inflated price. The doctor wouldn't negotiate and demanded the full fee. Neither the doctor, nor I, knew this would happen until the procedure was already done.

It feels like an agreement, to me, when the practice takes on a patient knowing who their insurer is. I feel like the reimbursement rate that insurer has negotiated, regardless of whether the insurer ultimately covers any procedures, should act as a cap for the fees charged to the patient. It feels a lot like negotiating a contract, except that one party gets to unilaterally change the amount of consideration. How does that fly?

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

#62

Post by r0m4n0 »

Seeing the price range you pay is interesting, but I'm not sure what we are supposed to do with it.

My wife had her prenatal anatomy scan a few months ago at Stanford medical, $11000 for a 1 hour ultrasound. I personally was on the hook for around $500 and insurance paid $10500.

End of the day, what say do we have as consumers? How did the insurance company negotiate a rate of $11,000? Does the insurance company really care when every year they can just increase premiums and shrug and go "costs are going up! sorry!"

It feels a lot like a pyramid scheme, at some point the gravy train has to stop

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

#63

Post by jonathan-adly »

I am one of the people responsible for making these lists. The fact that the general public as well as journalists think this data is accurate in anyway is really funny. This an exercise of futility that only increases the overall cost and provides job security for me :)

No one working in a hospital knows how much do we acquire things for, or how much we get paid for doing things in advance. And only like 8 people can tell you that information 3 months after the fact.

Take the simple exercise of figuring out cost/revenue of an aspirin administration.

Cost depends on: 1. Are you an outpatient/Obsveration v. inpatient v. ED? 2. Are you on Medicaid? 3. Is the hospital a part of GPO organization or not? 4. Is contractual obligations of GPO includes/excludes Aspirin?

Reimbursement depends on: 1. Insurance 2. Group which you are under the insurance from 3. Contract language whether its a fee/service or bundled 4. Is the visit covered or not 5. how the visit/procedure was coded (most important and opaque factor)

Everybody in the know, knows that these lists are a joke, but no one can prove it.

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

#64

Post by sxg »

vmception wrote: post #55

Great, now mandate that it is viewable via API Can even use the healthcare industry standard for EHR which is JSON and RESTful

Have JSON and REST been meaningfully adopted in healthcare? I thought most things still used the god-awful HL7 with hopes of migrating away.

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

#65

Post by twistedpair »

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.

Ever heard of coupons, rebates, bundles? All ways of adjusting pricing based on consumer price sensitivity.

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

#66

Post by [deleted] »

peterangular wrote: post #60
throwaway0a5e wrote: post #50

Earlier quoted context omitted.

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 t…

[deleted]

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

#67

Post by disgruntledphd2 »

dehrmann wrote: post #49
gfodor wrote: post #33

It will be fun to watch people be positive on this until they are reminded who we have to thank for it. Edit: CNN hasn't forgotten, notice the obvious negative spin, with literally zero argument of how this may be beneficial: https://www.cnn.com/2021/01/04/politics/hospital-price-trans...

Biden doesn't run his mouth when he shouldn't, but foreign policy with China and along the southern border are essentially the same as under Trump, and the Afghanistan withdrawal alienated some NATO allies. Biden is carrying over more of Trump's policies than you'd expect.

Presidents come and go, but the Blob is eternal.

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

#68

Post by gwbrooks »

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.

It's not as pervasive, but a good deal of consulting work is priced, at least partially, by the size of the problem you're solving rather than the labor required to solve it.

That can lead to price discrepancies similar to (although perhaps not quite as severe) as what you see in healthcare.

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

#69

Post by mullingitover »

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.

> Next step would be for hospitals to quote the same price for the same procedure no matter if or where you are insured.

After that, decouple health care from employment.

Finally, fully excise the connection between health care and ability to pay.

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

#70

Post by jjoonathan »

pkaye wrote: post #51
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.…

Alternative spin: Medicare/Medicaid are the only insurance that is any good at keeping prices under control. Everyone else in the medical industry is in the city, bilking people who have money. Expanding medicare/medicaid will help us slowly bring costs down, more in line (PPP-adjusted) with the rest of the developed world.
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