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

211–220 of 463 posts

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

#211

Post by bjt »

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…

Not all health care is heart attacks. "Health care" is a huge bucket containing everything from buying a bottle of cough syrup to the heart attacks you mention.

For life threatening emergencies, I'm with you. Let's fund that care through the state.

But excluding the market from everything is not the answer. The problem with using insurance for all these non-urgent things is that insurance distorts the market and price discipline goes out the window.

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

#212

Post by kazinator »

nickff wrote: post #208
snarf21 wrote: post #155

Earlier quoted context omitted.

This is why we need reference based pricing. You can't charge more than 1.2 * Medicare and if you pay cash, you get the Medicare price. This change alone would remove 25+% of unnecessary bloat from the US system.

> "This change alone would remove 25+% of unnecessary bloat from the US system." Where do you think the money is going? Insurance companies are not as profitable as you might think, drugs are not a massive burden on healthcare expenditures, and many hospitals are non-profits. The truth is that most of the money is going to staff wages; if you want to reduce healthcare spending, the only way to do it sustainably is to…

> many hospitals are non-profits.

That can't possibly be true of a hospital that charged $3000 for something on Tuesday, and $53000 for the same thing on Friday.

(Under reasonable assumptions like that Tuesday wasn't done at a $25K loss relative to breaking even; why would such be the case? And that they are busy with procedures, not simply doing a way overpriced procedure once every few weeks, and then just burning through cash in between that time.)

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

#213

Post by long_time_gone »

lotsofpulp wrote: post #166
long_time_gone wrote: post #153

Earlier quoted context omitted.

==We have at least 3 different taxpayer funded healthcare programs specifically so not everyone can get access to equal care== Add in CHIP and the VA (Tricare). We've taken every vulnerable part of society (older, poor people, poor children, injured veterans) and given them government-paid, universal healthcare. This is around 100 million people. Everyone left over is thrown into the private insurance pool. These peo…

>given them government-paid, universal healthcare This is meaningless if the quality of healthcare is not the same. There are numerous hurdles placed for various different people to get the healthcare, effectively restricting access to healthcare itself.

No doubt. I wasn't trying to comment on the quality or access, just a point on how we have "solved" the healthcare problem over time.

Taxpayers cover the neediest, leaving the healthiest to for-profit insurers. The healthiest have no incentive to make sure the programs for the neediest actually work or are accessible.

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

#214

Post by throwaway23438 »

texasbigdata wrote: post #205
throwaway23438 wrote: post #129

Earlier quoted context omitted.

I've often wondered what would happen if you went to the ER, carried no identifying documents, and just refused to identify yourself. Just hope nobody recognizes you there. Giving a fake name is fraud, and people have been arrested for doing that at the ER. (Fuck America.) But I don't know that there's any legal obligation to give any name at all. If you don't give them a name, you're not lying to them, and oops, loo…

I believe legally they have a duty to provide care.

Yes, that's my understanding. So wouldn't refusing to identify yourself be an effective way to avoid a bill, without the criminal exposure of giving a fake name or ID?

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

#215

Post by jimmygrapes »

cwkoss wrote: post #89
disgruntledphd2 wrote: post #67

Earlier quoted context omitted.

Presidents come and go, but the Blob is eternal.

It is funny/depressing to think how different our country would be today if Bernie had been the 2016 dem nominee.

The most depressing thing is that it likely wouldn't have changed much. Congress (of which Bernie is still part of and has been for decades) is the one with the power to make these changes, the President is just the scapegoat/hero.

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

#216

Post by peterangular »

nradov wrote: post #135
peterangular wrote: post #53

Earlier quoted context omitted.

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 o…

> Bundled payments give providers the freedom and financial incentive to find innovative ways to efficiently deliver high quality care

Until someone financially incentivizes a higher quality of care I don't expect to receive it, especially by a bundled pricing model.

> 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.

And as someone who's been billed insane amounts for things like OTC painkillers I disagree with this so hard. I have zero, and I mean zero, confidence that they will not continue to overcharge me. When everything is individually coded then at least a patient can go back and "look at the receipt"...

In my adult life I realize that almost everything is weaponized against me (the patient) in healthcare. I cannot expect in good faith that removing the line items from the receipt will help me in any way. In America, I can only expect this to hurt me or I'd be an idiot.

Sorry to disagree, but there is no way that bundled pricing is going to serve the patient better as it makes auditing services rendered much much harder. As someone who's had to get into the weeds on this stuff between insurer, hospital billing, etc. I can only imagine that bundled pricing would have made my life more difficult as it really did come down to the codes.....

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

#217

Post by nickff »

lotsofpulp wrote: post #137
rpmisms wrote: post #82

Earlier quoted context omitted.

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.

The parent comment never said anything about President Obama's desires regarding the Affordable Care Act, just that his 'brilliance' resulted in this outcome.

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

#218

Post by eganist »

nickff wrote: post #208
snarf21 wrote: post #155

Earlier quoted context omitted.

This is why we need reference based pricing. You can't charge more than 1.2 * Medicare and if you pay cash, you get the Medicare price. This change alone would remove 25+% of unnecessary bloat from the US system.

> "This change alone would remove 25+% of unnecessary bloat from the US system." Where do you think the money is going? Insurance companies are not as profitable as you might think, drugs are not a massive burden on healthcare expenditures, and many hospitals are non-profits. The truth is that most of the money is going to staff wages; if you want to reduce healthcare spending, the only way to do it sustainably is to…

> increase the numbers of doctors and nurses

and tort reform to manage the lawsuits to enable lower malpractice insurance costs.

and a scheme to drive down med school pricing. Maybe more competition? Enabling more MD and DO schools? There are <200 medical schools (both MD and DO schools) in the US.

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

#219

Post by knicholes »

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…

I never pay for this.

"No cavities again! Would you like a flouride rinse?" "Why would I do that? I have flouride in my mouth rinse and my tooth paste." "Well, ours is a higher concentration that I paint onto your teeth." "Didn't you say I had no cavities?" "Well, yeah." ".... so what I'm doing seems to be working without your rinse" "Well, it's only $16" "My flouride rinse has the exact same active ingredient as yours and costs $5 for an entire bottle." And it just goes on and on.

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

#220

Post by ben0x539 »

hamburglar wrote: post #187
haliskerbas wrote: post #136

Earlier quoted context omitted.

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…

I don't think consumers budgeting can realistically be the control on the growth of healthcare costs. For one thing, people's budgets vary too wildly.

Healthcare should simply be "free", ie budgeted into the operation of a modern society, like infrastructure costs and education.

Post reply on HN