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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

#111
post #99

Earlier quoted context omitted.

Insurance has the worst moral hazard: the winning strategy is to sell a product that pretends to cover your customers but actually doesn't. Your customers give you money for nothing and they will only realize it once in a blue moon. You can probably buy off the few who are capable of causing actual blowback, and if that doesn't work just rebrand. Until everyone becomes a contract lawyer capable of devoting weeks to i…

Aren't insurance rates regulated meaning if they payout a smaller amount than expected the rates will go down next year?

Now; I think the "medical loss ratio" requirements were one of the most important features of the ACA.

One of the worst offenders from the before-times was an insurance plan targeted at college students that had a 10% MLR.

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

#112
post #91

Earlier quoted context omitted.

> 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. Sili…

Any ambitious and smart enough American who wants to make a high income in exchange for working hard at prep has a choice of jobs they can go into. Many people who go into medicine are not necessarily the most passionate about medicine, but want a high paying, prestigious job. So yes, it does effect the supply of future and even current psychologists and doctors. Supply is dictated partly by cost of that supply vs th…

> Any ambitious and smart enough American who wants to make a high income in exchange for working hard at prep has a choice of jobs they can go into.

I suspect that the number of people who are driven solely by money and prestige is smaller than you believe, but even so, careers in different fields aren't fungible for the simple fact that even ambitious and smart people aren't universally capable of excelling in any field they choose. A top heart surgeon, for instance, wouldn't necessarily have the ability to be a top software engineer, even if he or she tried, just as a top software engineer wouldn't necessarily have the ability to be a top heart surgeon.

> So yes, it does effect the supply of future and even current psychologists and doctors.

Do you have any hard evidence indicating that the lure of big tech jobs is reducing the number of individuals who are pursuing careers in psychology, medicine, law, etc.? A study perhaps?

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

#113
post #101

Around 2012 before my wife and I were married, we both got pneumonia. I was insured through my employer, she was uninsured. We went to urgent care at the same time on the same day, saw the same doctor and got prescribed the same drugs. About a month later when the bills came, her bill with no insurance was somewhere in the $160 range. My bill after insurance was nearly $300. I'm still peaved about this.

Was there any difference in ability to sue the provider in case things went wrong?

I heard that sometimes they ask the uninsured to sign away the ability to sue the doctor and get lower prices in return. I am not too sure about details, this is just hearsay.

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

#114
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...

I mean, that's nice, but I'm not going to fall all over myself thanking the people who have fought viciously for decades to maintain the current profit-driven health care system and block single payer health care. It's like an abusive spouse who, out of the blue, brings you flowers and chocolate.

Wasn't really my point. My point is that you should expect to see all kinds of mental gymnastics around answering the question of if this is a positive change or not.

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

#115

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 ca…

>> 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? Those considerations aren't part of what anyone calls cost. How much does the hospital pay for aspirin? How much do they pay someone to administer it to a patient? That's cost. If it's very complicated…

This. It's telling that people working inside this system operate on a totally different set of rules for how to determine basic things like the cost of some input.

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

#116

Earlier quoted context omitted.

That sounds pretty unreasonable. Most people can barely stay on top of payments with a payment plan, let alone paying everything upfront

That's why they're so eager to get the payment upfront that they'll give a heavy discount. Apparently a lot of people have trouble keeping up with their bills.

Especially after a major traumatic event that requires an ER or hospital stay and especially if that bill is 5 or 6 figures.

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

#117
post #58

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 th…

Sometimes medical procedure names have commas in them. Instead of text qualifying them, it can be faster to write code that uses a different semi-standard delimiter.

It sucks, but, like, I don't really blame people for being in a hurry to fix a problem.

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

#118
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...

I'm not a fan of the guy, but this is probably the most important/good thing he did with his presidency. Price transparency is the most fundamental first step to driving down health care costs. Once people get a taste of it, it will drive even more, better and accurate data. Start real conversations about costs and open the door to measureable improvement through innovation.

Price transparency is a pointless shell game designed to keep everyone strung along on the entrenched, failed system. When you're having a heart attack, the last thing you're doing is shopping around for the best prices on heart attack emergency treatment.

The free market has no place in health care, because in the hands of the free market the first thing that will happen in a life-threatening emergency is for you to transfer 100% of your wealth to the party that has 100% of the leverage.

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

#119

Earlier quoted context omitted.

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.

> 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.

This is not correct for all practices

My wife's practice (of plastic surgeons medical providers only in a reconstructive practice 75%, cosmetic 25%, attempting to be in-network with every insurer, with administrative front-office doubling as billing, and dedicated personnel for resubmits) vastly prefer cash paying because they get the money right then, and they don't have to haggle with insurers around things like pre-authorization, billing, etc. Insurers regularly make physicians go through the ringer to get an pre-authorization for a vital surgery. Even worse, insurers will ask for a "peer to peer" and then have some underqualified medical provider understand what a board certified surgeon is doing, based on a complex diagnosis, and not understanding the actual surgeries or procedures involved. Insurers will forget pre-auths, and then reject billing, and they have a whole bunch of shady practices around, even with in-network practices for cancer cases.

So much of this price transparency stuff is a giant racket because it helps insurers, and not the actual medical doctors, PAs, NPs and other medical providers. However, it is medical insurers & Payors which are driving all the paperwork (Horrible EMRs, ICD codes, pre-auth, auths, etc) along with growing the tsunami of administrative personnel)

Insurers try to use being out-of-network to reject medical bills, so they use it as a weapon vs practices/hospitals, very effectively unless it is an emergent case (medical emergency).

What is completely missing from this conversation is who this benefits, who this harms, and how insurers exploit the status quo.

Cash paying customers should always be the cheapest option, since there is little overhead for them.

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

#120

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

Even better: Mandate them to upload the data to some government system and let them provide a central API, transparency reports, ...

Germany did this for gas stations:

> Since 31 August 2013 companies which operate public petrol stations or have the power to set their prices are obliged to report price changes for the most commonly used types of fuel, Super E5, Super E10 and Diesel "in real time" to the Market Transparency Unit for Fuels.

https://www.bundeskartellamt.de/EN/Economicsectors/MineralOi...

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