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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

#221

Post by joshAg »

jjoonathan wrote: post #210
joshAg wrote: post #141

Earlier quoted context omitted.

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…

Yes, in a well-regulated insurance market the winning business model isn't deceit. That's the point of the regulations. Deceit can take many forms, and I'd argue that undercapitalization is actually one of them. "There's a trap clause on page 23 of the telephone book contract" is only the simplest strategy an insurance company can use to lemon-drop. "We ask our customers to do an impossible information wrangling task…

I'm not saying it's not because of regulations. I'm saying it's not just the regulations on payouts and the regulations on payouts probably aren't even the most important, because all the regulation in the world around ensuring the insurer can't skip out on payouts will do nothing for "Oops we invested badly and have literally no money with which to pay your completely valid claim".

The payouts regulations are still good and necessary because that's way better than requiring people to find out the hard way through shitty claims processes and denials and word-of-mouth reputation, but they're in no way sufficient.

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

#222

Post by jrochkind1 »

peterangular wrote: post #35
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.

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…

>> They have a column called "Uninsured cash price." These prices are > 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 doesn't sound like an "inflated" price? 25% of what insurance companies are billed for?

I'm confused. I'm not sure y'all are talking about the same things?

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

#223

Post by tormlop »

SavantIdiot wrote: post #192
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...

You mean Bill Clinton in the early 90's? It was part of the Clinton health care reform. But maybe you're not that old. ;-) Every president has pushed for this except Bush Jr. Glad it finally happened even if it was under who I consider to be the worst president* in the last 100 years of US history. Doesn't mean I need to thank him. If you were being tortured in a Mexican cartel prison, would you thank the torturer fo…

You seem upset.

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

#224

Post by wins32767 »

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…

How effectively can you actually shop for medical care? Providers lobby against public measures of effectiveness so basically only payers have enough data to actually judge who is effective and people scream when their doctor choice gets restricted for any reason.

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

#225

Post by colejohnson66 »

earksiinni wrote: post #188
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.

I’d’ve assumed that it’s all done by software that takes into account all the factors, but I wouldn’t be surprised if it’s a step-by-step guide in a physical book. (Hospitals are horribly outdated with technology)

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

#226

Post by fragmede »

karmelapple wrote: post #181
danShumway wrote: post #148

Earlier quoted context omitted.

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…

Sort of? As we're seeing with the pandemic, a not insignificant portion of the population is so used to healthcare being utterly inaccessible that animal medication seems like a reasonable alternative. That $16,000 pill isn't getting to patients, people are simply dying without it instead, going to faith/crystal "healers" instead.

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

#227

Post by the_imp »

I don't understand why US healthcare providers are allowed to charge different customers a different price for the same service or good.

As this is clearly being systematically abused to extract the most wealth from patients and insurance companies, is anyone seeking to require healthcare providers to not provide such variable pricing?

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

#228

Post by nickff »

kazinator wrote: post #212
nickff wrote: post #208

Earlier quoted context omitted.

> "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…

Very few hospitals do cost-accounting, so they don't even know how much things cost; this results in the inconsistencies you see in prices.

From Wikipedia:

>"In 2003, of the roughly 3,900 nonfederal, short-term, acute care general hospitals in the United States, the majority—about 62 percent—were nonprofit. The rest included government hospitals (20 percent) and for-profit hospitals (18 percent)"

https://en.wikipedia.org/wiki/Non-profit_hospital

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

#230

Post by monocularvision »

loeg wrote: post #83
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."

You’re probably thinking of “healthcare ministries,” which are not insurance (they’re scams).

I personally know several families that are a part of these co-ops and they have had incredibly expensive things fully paid for. What makes you call them a scam?
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