Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

healthcaredive.com

Post reply on HN
Print view View original

131–140 of 463 posts

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

#131

Post by kristjansson »

saalweachter wrote: post #111
ipaddr wrote: post #99

Earlier quoted context omitted.

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.

To save those looking it up: medical loss ratio is the fraction of premiums an insurer spends on actual healthcare expenses. 10% means 90 cents of every dollar paid in premium goes to admin/profit/etc.

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

#132

Post by elliekelly »

minsc__and__boo wrote: post #88
gwright wrote: post #81

Earlier quoted context omitted.

I think the point of making the lists public is to provide information that can lead to iterative improvements. I'm not sure it will do that but I'm a bit more confident that it is a necessary first step.

I thought the lists were a red herring for the problems with privatized healthcare - i.e. look at how complicated pricing is, not how it is being complicated by for-profit middlemen.

One interesting aspect of the No Surprises Act regulations that would seem to support your claim is the three hour required waiting period for non-emergency same-day procedures. The waiting period is ostensibly to prevent patients from feeling rushed or pressured into agreeing the price but the "long wait" boogeyman is another common red herring in the healthcare discussion and the three-hour wait seems unnecessary. The wait applies only in non-emergency situations so logic would follow that if the quoted price were too high the patient could leave.

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

#133

Post by [deleted] »

ipaddr wrote: post #99
jjoonathan wrote: post #80

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?

[deleted]

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

#134

Post by monocasa »

ipaddr wrote: post #99
jjoonathan wrote: post #80

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?

So that encourages greater payouts more or less synced with greater premiums in order to increase year over year real profits.

And given that the payouts are very nearly a function of how hard the insurance company can negotiate, they can simply choose to call off the negotiations when they reach their target amount.

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

#135

Post by nradov »

peterangular wrote: post #53
nradov wrote: post #23

Earlier quoted context omitted.

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 expe…

Procedures will always be coded using a terminology system like CPT4 / HCPCS / SNOMED CT regardless of the payment model. The issue isn't coding but rather who bears the risk.

Bundled payments give providers the freedom and financial incentive to find innovative ways to efficiently deliver high quality care. No one benefits when hospitals have a separate line item charge every time a nurse administers a pain killer over the course of a hospital stay.

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

#136

Post by haliskerbas »

EvanAnderson wrote: post #61
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…

> 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 procedur…

Reminds me when my dentist charged me $50 for a cup of fluoride (nothing too special about this fluoride).

I asked why they said it would be covered. They said when they checked with insurance it says it’s covered, but for my age or whatever it’s not actually covered.

So then I said why is it my fault that you gave me something you said was free but actually wasn’t because your check wasn’t thorough enough?

They said they already spent it so someone has to pay…

In the end I didn’t pay for the fluoride after hours of argument.

Next year at a different dentist, same situation. I learned my lesson and just paid for the damn fluoride. Land of the free, home of the brave!

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

#137

Post by lotsofpulp »

rpmisms wrote: post #82
mullingitover wrote: post #73

Earlier quoted context omitted.

> These prices are There are some clever insurance companies whose entire model is "tell the hospital you don't have insurance, get the cash price, pay it with this debit card we give you."

Not technically "insurance", these are cost-sharing companies. Often religious due to Obama's brilliance.

Is there evidence that Obama wanted those religious exemptions and bullshit cost sharing plans? I would be willing to bet that was a concession to other politicians in Congress in order to get ACA passed.

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

#138

Post by Retric »

monocasa wrote: post #134
ipaddr wrote: post #99

Earlier quoted context omitted.

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

So that encourages greater payouts more or less synced with greater premiums in order to increase year over year real profits. And given that the payouts are very nearly a function of how hard the insurance company can negotiate, they can simply choose to call off the negotiations when they reach their target amount.

Only up to a point, they still accept or recheck claims arbitrarily to get closer to their targets. Worse they have incentives to decrease efficiency by increasing paperwork etc.

Private medical insurance in the US is a horridly inefficient system. Separating the claims process from insurance companies hands might help, but their incentives are never going to line up with consumers.

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

#139

Post by danShumway »

jonathan-adly wrote: post #63

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…

Requiring hospitals to make these lists may help the situation improve.

> 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.

This is the problem. There has to be prolonged pressure put on multiple parts of the system until it will start to optimize in different directions.

A nontrivial part of why no one knows these things in the hospital is because nobody has to know these things, the entire system (not just the hospital but the surrounding insurance system, the billing systems, the vendors, etc) is used to not needing to care about these things.

So these lists, as imperfect as they are, increase that pressure a little bit. Ideally, seeing the price fluctuation and seeing the reactions of doctors to these lists will prompt more in-depth questioning[0] from regulators, judges, and consumers. The fact that the lists are a joke is why they're not a joke. People need to be publicly reminded, again and again, over and over, that the way health procedures in the US are priced are generally broken, often arbitrary, sometimes opportunistically exploited, and almost always unnecessarily complicated.

The more obvious that becomes, the more attention that other parts of the system will get.

[0]: https://www.healthcaredive.com/news/baffled-judges-price-tra...

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

#140

Post by IMTDb »

jonathan-adly wrote: post #63

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…

The spirit is here is that you should fully open all those factors and fully open how they influence the cost paid by the patient. Make an excel sheet, a web app, an API, whatever. But let people know and simulate the cost - include all required factors.

If the prices you charge differ from the prices provided by your open data platform, or if some factors are omitted from the open platform, you should get a lawsuit on your hand - and lose it.

If your excuse is that building the open data platform is too complex and expensive because too many variable are involved, explain how you were able to build a reliable system internally - and open that one.

If you cannot do that as well, you know it's time to rethink your pricing model, in order to simplify it.

The end goal of the regulation is to push as many health institution as possible to reach the conclusion that they really need to rethink their pricing model.

Post reply on HN