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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

#331

Post by someguydave »

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…

if most patients were paying cash with no insurance such that hospitals had to compete on price all of these items would somehow become clear

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

#332

Post by lotsofpulp »

monocasa wrote: post #269
lotsofpulp wrote: post #260

Earlier quoted context omitted.

>You'd think that shopping around would've helped in that case, but the word got out somehow to the other insurance companies and they were giving us similar quotes. Employers are welcome to purchase healthcare.gov plans that are not allowed to price based on pre existing conditions: https://www.healthcare.gov/how-plans-set-your-premiums/ If an employer wants to self insure and restrict their risk pool to only their…

> Employers are welcome to purchase healthcare.gov plans that are not allowed to price based on pre existing conditions: Which are stupid expensive for anyone much above the poverty level. > If an employer wants to self insure and restrict their risk pool to only their employees, then they have to pay for it A 250 person company wasn't self insuring or restricting their risk pool to only their employees. They wouldn'…

If they were not restricting their risk pool, then how would a couple kids with cancer affect the company's premiums? The costs would be distributed across a much larger population.

When I was shopping around for health insurance for my businesses, the premiums were the same as what they would have been individually on healthcare.gov. Kaiser has a good report showing the costs are not that different based on firm size:

https://www.kff.org/report-section/ehbs-2020-section-1-cost-...

The cost of healthcare is pretty predictable, and spread over a sufficient population converges to the same numbers. Only option I can think of is people were thinking that the employer reduced their portion of healthcare they were subsidizing, and so people thought premiums were going up since the size of the portion they were expected to pay went up? Most people do not really know to look at box 12 code DD of their W-2 to know what is happening with their healthcare insurance premiums.

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

#333

Post by gfodor »

mullingitover wrote: post #304
gfodor wrote: post #298

Earlier quoted context omitted.

There is no silver bullet. Your absolutist perspective undermines your argument.

On the contrary, there is, the problem (for some) is that it is indeed a bullet and the people getting (figuratively) shot are the ones who, under this system, are getting very fat on the inefficiencies. They're able to use their illicit wealth to exploit our very broken system of government to maintain their rent-seeking successes.

No system is perfect. If the US had a universal healthcare system, it would suck in many ways. People do, after all, travel to the US for medical care. My point is that there is likely a better local optimum out there than the one you suggest, and coming off as if the problem of healthcare is “solved” is news to people under any system who are suffering due to its inefficiencies or inequities. For example, I live in the US - I have CF and have been taking a drug for more than a year that is extremely effective. It has yet to be approved in some universal healthcare systems, likely due to its high cost (given the small patient population and its extremely high R&D costs.) This is literally killing people who would be alive had they been able to access the drug.

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

#334

Post by lostlogin »

slownews45 wrote: post #154
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…

God, I used to work in medical billing, and people would think these file format issues were some kind of scheme. NO they are not. They deal with the obvious problem that clinicians are NOT always programmer friendly, and will put things like tabs in case notes, will use commas etc. At some point you use a delimiter that is much less likely to be used - | - is one of those, not a lot of clinicians use it and you can…

> God, I used to work in medical billing, and people would think these file format issues were some kind of scheme.

I think it must be at this point. The hot garbage that is medical data formats (HL7, in particular) and the ways you can break it as a user, unknowingly and silently. It’s incredible that a format this bad has hung around this long.

It’s not ok that users can type certain characters into a field and break the system.

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

#335

Post by lostlogin »

batty_alex wrote: post #182
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…

> 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

> HL7

And there is the problem.

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

#336

Post by monocasa »

joshAg wrote: post #310
monocasa wrote: post #203

Earlier quoted context omitted.

> It's in the return on investments the insurer makes with the money they hold in trust ...sourced from the premiums. When they pull in more premiums, they have more money to invest.

No, it's sourced from the initial capitalization of the firm and then realized returns that are reinvested. You can't offer insurance until you're capitalized enough to handle claims on the same day the policy takes effect. Ideally the premiums will cover payouts and day-to-day business expenses, so the invested money can just keep being reinvested, hopefully into longer term and more aggressive investments. The prem…

The seed comes from initial investment, but if premiums weren't a major component of growth they'd just be an investment firm.

They don't have control over investment returns for the most part, so premiums are the only avenue for growth that they can do something about.

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

#337

Post by jeffdn »

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…

A substantial portion of the money spent on wages at primary care physicians offices is on staff to negotiate with insurance companies. At a previous employer, where I worked closely with many primary care physicians offices, it was not uncommon for there to be three or more staff members working entirely on billing. That is ludicrous.

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

#339

Post by mullingitover »

weberer wrote: post #297
mullingitover wrote: post #285

Earlier quoted context omitted.

We don't have to reinvent the wheel. Other countries have solved these problems. They have better health care than we do. It's measurable, it's been measured, and no surprise, they have flat-out superior outcomes. They are dramatically more efficient. Our market focus is a cargo cult.

What market focus? Prices were completely opaque until just a few months ago. Any economist on the planet will tell you that would lead to awful outcomes for everyone except the powerful healthcare lobby.

Yes, we have a thoroughly regulated, negotiated, contractually obligated system. You can't have a true "free market" in health care without some truly egregious outcomes because when people are in health crisis they will pay anything to stay alive, and we already know we won't countenance the (let's call it what it is) extortion that the free market would produce in those scenarios. Because we want to feel like it's a free market, because free market economics is a cargo cult when it comes to health care, we get the worst of both worlds.

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

#340

Post by alex_c »

peterangular wrote: post #278
wuliwong wrote: post #270

Earlier quoted context omitted.

>the very nature of profit/capitalistic societies means someone has to lose If by 'profit/capitalistic societies' you mean those allowing for voluntary exchanges between its people, I would disagree. As an adherent to the subjective theory of value, I think it is common that both parties in an exchange would consider themselves 'winners.' [0] [0] https://en.wikipedia.org/wiki/Subjective_theory_of_value

I'm in the Jim Camp school of thought where, in negotiation, there is no "win-win" situation. https://www.forbes.com/sites/jimcamp/2013/03/11/revisiting-w... The reason I am firmly in this school of thought is that I've made the absolute mistake of a decision to try for "win-win" situations in a capitalistic society, specifically in regards to contract negotiations and ultimately pricing/billing. When I'm making sure…

What is the definition of "win-win" that you are against?

I'm not familiar with Jim Camp, but the term is vague. The linked article to me mainly seems to argue that:

- the side with a better BATNA has more negotiating power (yes, of course) and

- a negotiator should avoid agreeing to a bad deal out of desperation (yes, of course - but not always easy to do)

I'm not sure how the concept of "win-win" specifically plays into it, so I think this is where definitions are useful.

To me, win-win doesn't make sense for transactional negotiations where there is only one dimension (usually price), but CAN happen for more complex negotiations with multiple dimensions where each dimension has different value to each party (price, time, volume commitments, etc...)

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