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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

#141

Post by joshAg »

jjoonathan wrote: post #80
EvanAnderson wrote: post #61

Earlier quoted context omitted.

> 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…

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…

Payouts and premiums aren't where the money is in insurance. It's in the return on investments the insurer makes with the money they hold in trust. From an insurer's point of view, the best market isn't one with no payouts, but one where there is a highly predictable amount of payouts, because the better they can predict how much they need to payout, the more aggressive they can be with their investments.

Yeah, there's a decent amount of regulation around payouts to protect the consumer, but it pales in comparison to the regulations around making sure that the insurer has enough liquid assets on hand, that the total valuation of their assets (ie investments) remains large enough, and that they're charging a minimum amount of premium for the risk that they're taking on.

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

#143

Post by throwthere »

garettmd wrote: post #115
phkahler wrote: post #96

Earlier quoted context omitted.

>> 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.

You're making the reasonable-sounding (but incorrect) assumption that the cost to the hospital of a drugs is the same for every patient. It's telling how people on the outside have no idea how complex the system is, as if there's one simple way to cost an item (hell, there's not even one simple way to cost an item with GAAP accounting for a widget). These lists are kind of worthless in the current iteration, but they'll hopefully get better with more targeted intervention.

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

#144

Post by EForEndeavour »

avs733 wrote: post #58
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 th…

This is the GDPR cookie popup annoyance equivalent of requiring hospitals to disclose their chargemasters, but not spelling out that the published data should be reasonably human-readabale. Malicious compliance.

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

#145

Post by jolmg »

NortySpock wrote: post #117
avs733 wrote: post #58

Earlier quoted context omitted.

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.

Or they could be using a legacy system that exports data in that format from times before CSV was invented/standardized.

For example, SCO Unix's Informix SQL's `UNLOAD TO SELECT ...` queries output in a format that's very much like what avs733 describes, only that the values aren't separated by pipes, they're terminated by them, so every record ends with a pipe character.

If that's the case, there's unfortunately no built-in option to get it to include column identifiers in the report. :(

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

#146

Post by joshAg »

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?

for admitted policies, usually yes. But it's not just that the rate for the next year goes down. Premium payments have to be refunded too.

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

#147

Post by mcguire »

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...

Even a blind squirrel finds a nut once in a while.

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

#148

Post by danShumway »

jonathan-adly wrote: post #123
phkahler wrote: post #96

Earlier quoted context omitted.

>> 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…

The cost of the aspirin depends on these things lol. Look up 340B. There is a drug called Oncaspar. It's >$16,000 for one patient, and 5 cents for another (acquisition cost). Same drug, widely different acquisition cost.

When two pills coming from the same company are being made at the same time on the same machines, then they both cost the same. It's pretty obvious that the patient status changes nothing about that. However, the hospital's acquisition cost is variable because you're further down the supply chain and you're seeing the exact same kinds of arbitrary behind-the-scenes price swings that this article is talking about.

It sounds like within the industry, hospitals are facing the same problems as consumers, and they need more price transparency from their suppliers as well. Hopefully increased requirements towards hospitals to explain their pricing will lead to hospitals demanding slightly more transparency and slightly more consistency from the other companies they work with.

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

#149

Post by twofornone »

mullingitover wrote: post #118
trixie_ wrote: post #103

Earlier quoted context omitted.

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…

>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.

This is a tired, nonsensical argument. The vast, vast majority of medical procedures are not last minute emergencies. Furthermore, with price transparency you will clearly be able to evaluate which hospitals may or may not be generally in your price range and choose a default to visit for an emergency (assuming you're not carted off in an ambulance).

More importantly, this will absolutely force competition and some degree of price correction.

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

#150

Post by mulmen »

avs733 wrote: post #58
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 th…

Pipes are commonly used as delimiters in healthcare settings [1]. A quick quack suggests Python, Javascript and Perl ecosystems have HL7 parsing libraries available. I assume most languages do.

[1]: https://en.m.wikipedia.org/wiki/Health_Level_7

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