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

#181

Post by karmelapple » Wed, Sep 22, 2021, 6:33 PM UTC

danShumway wrote: post #148

jonathan-adly wrote: post #123

Earlier quoted context omitted.

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…

Drugs typically have a pretty in elastic demand. Whether it costs $16000 or $0.05 for a pill, the end user - whether a doctor or a patient - will simply figure out a way to pay for it to alleviate the pain, symptoms, and perhaps to avoid dying.

Seems like 340B (I hadn’t heard of this before, thanks!) may have been created with recognition of this inelasticity.

If we can limit prices this way, all it would take are a few more laws to put more price limits in place.

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

#182

Post by batty_alex » Wed, Sep 22, 2021, 6:34 PM UTC

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…

> 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.

They likely just exported the prices as HL7 from their EHR system and used Excel's built-in delimiter support, then called it a day

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

#183

Post by KarlKemp » Wed, Sep 22, 2021, 6:35 PM UTC

mulmen wrote: post #150

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…

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

Except they usually call them “tubes”.

(Can’t find the original source, but it goes “Cant breathe? Put in a tube. Can't pee? Tube. Can't poop? Tube. Bleeding? Tube. Infection? Tube. Heart attack? Tube.”)

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

#184

Post by karmelapple » Wed, Sep 22, 2021, 6:35 PM UTC

throwthere wrote: post #143

garettmd wrote: post #115

Earlier quoted context omitted.

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…

I wouldn’t call it worthless at all, because of the rest of your last sentence. It provides a starting point.

We need to start setting the expectation of transparency for some small subset of info to get further transparency. Change takes time, as much as we’d like it to drastically improve overnight for real life and death situations like medical prices.

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

#185

Post by pessimizer » Wed, Sep 22, 2021, 6:36 PM UTC

SamuelAdams wrote: post #11

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.

Yes but emergencies are the exception, not the norm for most hospitals. Most hospitals make 40-60% of their revenue on elective surgeries, ie things that can wait 2-6 months. So patients have time to shop around. Source: currently work at a big hospital in IT.

Emergencies are the norm, not the exception, for most people. Elective surgeries are mostly the well-insured and the wealthy. Poor working people go to the hospital when it hurts so bad that they're missing work, and when they miss work they don't get paid.

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

#186

Post by KarlKemp » Wed, Sep 22, 2021, 6:37 PM UTC

EForEndeavour wrote: post #144

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…

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.

Oh but, if you read slightly between the article’s lines, you’ll notice that the law does require both human- and machine-readable publication.

The machine-readable part is mandated here: https://www.federalregister.gov/documents/2019/11/27/2019-24...

As a taste of how specific this is:

    (5) The file must use the following naming convention specified by CMS, specifically: __standardcharges.[json|xml|csv].

And here’s the consumer-readability requirement for 300 “shoppable’ services: https://www.federalregister.gov/documents/2019/11/27/2019-24...

They aren’t always quite as stupid as people make them out to be, these lawyers.

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

#187

Post by hamburglar » Wed, Sep 22, 2021, 6:37 PM UTC

haliskerbas wrote: post #136

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…

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…

Yes, our medical/dental insurance industry has encouraged the attitude of “cost doesn’t matter, because it’s free to you (oh and besides, you can’t put a price on your health, can you, you cheapskate?)” which just serves to constantly let prices grow out of control. This is an instrumental part of how our healthcare costs got so high. It also is why it’s laughable to think of medical care as a free market: you can’t even find out what things cost before you buy most of the time. Not to mention that when you are in need of care, you often don’t have the luxury of shopping around.

What we really need is for people to stop thinking of insurance as a big blanket you buy that reduces the price of things to zero. That’s not what insurance is for. Insurance is supposed to be a system where you still pay for the cost of the good, but that buffers it for you so when you get an outlier cost, it doesn’t break you. It doesn’t make the costs of things go away. On average, you should end up paying a little more than the cost of your healthcare by purchasing it through an insurance plan. A high deductible plan does this: you actually pay the cost of all your healthcare up until a certain point out of pocket, and if you reach a certain amount (which is pretty high, but significantly less than the premiums on a low-deductible plan), the insurance takes over. This makes you actually aware of the prices of things and is healthy. Not to mention the insurance is a hell of a lot cheaper.

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

#188

Post by earksiinni » Wed, Sep 22, 2021, 6:39 PM UTC

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…

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

In your opinion, is this something that could be exhaustively modeled in software? What would the bottlenecks be? I'm guessing probably the biggest is the fact that the necessary data isn't digitized, or if it is, it's not easily accessible.

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

#189

Post by satronaut » Wed, Sep 22, 2021, 6:39 PM UTC

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…

You're in charge of literally saving lives but you can't handle something as standard as cost estimation? How can you joke about that? Figuring out the cost to the hospital in terms of materials and labor should be standard.

Example, an x-ray. You know you need to pay an x-ray tech X$/Hour and after doing 1,000's of x-rays, a hospital should have it down that somebody with a broken leg will require N hours (maybe .5, maybe 1.5) to setup and take the x-ray. x-ray film costs HAVE to be known. the x-ray machine life time and number of shots should be known. Then do something like a 30% surcharge for admin fees and boom, x-ray cost.

Every other industry estimates this way, what makes a hospital different?

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

#190

Post by mchusma » Wed, Sep 22, 2021, 6:39 PM UTC

jonathan-adly wrote: post #167

IMTDb wrote: post #140

Earlier quoted context omitted.

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…

There is no internal reliable system. Healthcare in the US uses faxes. People here thinks that their local hospital is Google, while in reality it's a badly managed/badly funded 100 year old non-profit organization full of middle managers who just learned how to use their email.

I think if your point is "the system is broken today", basically everyone agrees with you.

If your point is "it is not possible to have transparent pricing", that seems also insane.

IMO we should pass a law that says if you can't give people transparent upfront pricing, you can't bill them at all. The idea that you can "figure out a price later" seems absurd.