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

#381

Post by danShumway » Wed, Sep 22, 2021, 9:08 PM UTC

learc83 wrote: post #374

danShumway wrote: post #354

Earlier quoted context omitted.

> There's nothing inherent to Capitalism that prevents variable priced contracts. Definitely not the norm though, and it is inherent to Capitalism that price transparency is an important part of creating an efficient market. But sure, it's not a rule . A lot of common things in Capitalism aren't rules, but they're still often signals of a healthy market. > You won't even get an upfront price for something as simple r…

>Definitely not the norm though It most certainly is the norm when purchasing complex custom services. >A contractor will not however replace the framing and then charge me after the fact. They'll discover the rotten framing, inform me of the new conditions and the new price, and then let me decide. A good contractor will walk me through that process. If a surgeon could keep your chest open on an operating table whil…

> It most certainly is the norm when purchasing complex custom services.

An x-ray is not is not a complex custom service.

> But how much is that worth when the entirety of the hospital visit is going to be a variable cost?

This is the exact same argument that hospitals used to use against itemized pricing, and yet it turns out that requiring hospitals to give itemized bills on request has pretty solidly been a good thing for consumers.

There are a huge number of reasons for this, not the least being fostering competition and putting natural pressure on the market to justify its prices helps it become more efficient, and these kinds of opaque systems will almost always naturally lead to inflated prices. There's little reason to believe that up-front price transparency for individual itemized procedures and drugs wouldn't also be good for the same reasons.

At the very least, this would help with the many health decisions that consumers make that aren't happening during life-threatening situations. Most of the time that I get an x-ray, most of the time when I'm being offered pain medication, most of the time when I'm making decisions about whether or not to opt for anesthesia before a procedure, I'm awake and not in danger of immediately dying.

It really doesn't make sense to keep leaning on the most extreme life-or-death situations as a defense for why a hospital can't walk me through the price differences in several different brands of pain medication. But sure, we'll make an exception for surgeons operating while a patient is literally unconscious during a time-sensitive procedure. Most health visits (and the vast majority of all preventative care procedures) do not fall into that category.

> jonathan-adly has done a great job explaining why drug prices are difficult to calculate upfront.

Let's make this simpler. johnathan-adly says:

> The cost of the aspirin depends on these things

Here's Rite-Aide's page that comes up when I search for an aspirin: https://www.riteaid.com/shop/medicine-health/pain-fever-reli...

Why is it that Rite-Aid can give me an upfront cost for an aspirin, and a hospital can't? 340B is a rebate system, it doesn't force doctors to avoid talking to patients about the baseline price differences between comparable off-the-shelf name-brand and generic drugs.

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

#382

Post by r0m4n0 » Wed, Sep 22, 2021, 9:10 PM UTC

itisit wrote: post #126

r0m4n0 wrote: post #62

Seeing the price range you pay is interesting, but I'm not sure what we are supposed to do with it. My wife had her prenatal anatomy scan a few months ago at Stanford medical, $11000 for a 1 hour ultrasound. I personally was on the hook for around $500 and insurance paid $10500. End of the day, what say do we have as consumers? How did the insurance company negotiate a rate of $11,000? Does the insurance company real…

The insurance most definitely did not pay $11,000 USD. They paid a percentage of an adjusted figure, and the balance was passed on to you. Billing and payment amounts usually differ by an order of magnitude.

Oh yea they paid it. Negotiation for rates happens before you pay coinsurance. I’ve called them and discussed it all. They send a $10000 check.

Odd part was in this case, we had a follow up ultrasound for another $2500 for a second hour after they “saw something odd” and it turned out to be nothing. Second hour had billing codes that were 75% less for some reason.

https://imgur.com/a/Ffmt8YT

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

#383

Post by OrvalWintermute » Wed, Sep 22, 2021, 9:13 PM UTC

nradov wrote: post #23

peterangular wrote: post #7

Earlier quoted context omitted.

> You cannot always look at a service in isolation But in the American system it's setup that you must. This is the whole "coding" thing that you hear people refer to which is taking a procedure and breaking it into individual codes that can be used in billing you/your insurance. This was addressed in the "Methodology" section of the article: > Data was collected for three services, determined by specific codes. ---…

The US healthcare system is slowly moving away from the fee-for-service model and towards a value-based care model. Under that model, providers bear much of the financial risk. They might receive a single bundled payment for a joint replacement including all follow-up care, with penalties for failing to meet clinical quality measures. Or they might receive a flat per-patient per-month fee to completely care for peopl…

>Under that model, providers bear much of the financial risk.

Actually, practices currently bear the risk already, because they are subject to reimbursements unless they are cash-paying. Remember, the patients are regularly not the bill payors - the Payors are actually insurance companies/medicare/or, rare HMOs out of the area.

> They might receive a single bundled payment for a joint replacement including all follow-up care, with penalties for failing to meet clinical quality measures

Certain medical interventions like cancer treatment or joint replacement may require a long tail of treatment, counseling, physical therapy, aftercare, global periods, etc.

The applicability of that is fairly limited since many things do not trigger a global, and don't fit into this definition.

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

#384

Post by nickff » Wed, Sep 22, 2021, 9:15 PM UTC

kazinator wrote: post #372

nickff wrote: post #228

Earlier quoted context omitted.

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.wikipedi…

If you don't know how much things cost, how can you say you're doing accounting? If you're doing accounting you have a ledger which balances down to the penny, and the expenses are spelled out in there with concrete amounts. This is why that judge, as noted in the article, rejected the argument that the cost of an X-ray can be unknowable.

Cost accounting consists of more than just balancing a chequebook to the penny; you need to attribute expenses to specific procedures, which can get a bit tricky. It requires discipline and cooperation throughout the organization, which would likely be a huge change for hospitals (as I'm certain doctors would be loathe to log their time like lawyers do).

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

#385

Post by mrguyorama » Wed, Sep 22, 2021, 9:15 PM UTC

gfodor wrote: post #357

mullingitover wrote: post #344

Earlier quoted context omitted.

There may be edge cases, but on the whole if people in the US had the health care systems of the UK, France, Germany, Japan, or pretty much any other developed country, they would riot in the streets if the US system were suddenly forced on them.

lol dead people as “edge cases” - frame this one up - own it.

How many people died last year in the NHS because they couldn't get health care?

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

#386

Post by EamonnMR » Wed, Sep 22, 2021, 9:18 PM UTC

nebula8804 wrote: post #259

vmception wrote: post #55

Great, now mandate that it is viewable via API Can even use the healthcare industry standard for EHR which is JSON and RESTful

In the meantime, since we have the data, this could be a good project for volunteers to glue together all the different documents from the different hospitals into a single system. These files are provided as excel documents in what I assume to be a (hopefully) mostly unchanging location on each site. A script could download all the files, match up the procedures and then push it to a pretty tool for everybody to use…

I was thinking of doing this. I even started a bit, but I didn't end up getting very far. I'm torn between trying to run it as a service and running ads or whatever, or trying to run it as a wiki with contributors writing ETLs for individual hospitals and trying to tame the data set.

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

#387

Post by EamonnMR » Wed, Sep 22, 2021, 9:18 PM UTC

sxg wrote: post #64

vmception wrote: post #55

Great, now mandate that it is viewable via API Can even use the healthcare industry standard for EHR which is JSON and RESTful

Have JSON and REST been meaningfully adopted in healthcare? I thought most things still used the god-awful HL7 with hopes of migrating away.

As mentioned upthread, faxes are still in use.

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

#388

Post by spaetzleesser » Wed, Sep 22, 2021, 9:18 PM UTC

bcrosby95 wrote: post #41

toast0 wrote: post #22

Earlier quoted context omitted.

Networks are a double edged sword. They're a pain to use (especially for things where network facilities have non-network providers or network providers steer you towards non-network accessory care like labs and what not), but network agreements are also a way that insurers control costs. Forcing insurers to cover every provider means insurers can't exclude overpriced providers.

Yep. These agreements cut out some ridiculous fees some might try to charge. E.g. when my wife had surgery, the hospital tried to charge $20k for the surgery room and $20k for the recovery room. Our insurance pointed out that by their agreement they aren't allowed to charge for use like that. Instantly cut the hospital portion of the bill from $49k to $9k.

That’s the insanity. You are the same person, same procedure, everything same but somehow the hospital can reduce its bill from 49000 to 9000. That is just not normal for a business like a hospital where they have a ton of fixed costs (unlike a software company where delivery of their product often costs close to zero so they can easily give rebates). This seems to indicate that the 49k is an insanely high price with very high profit margin.

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

#389

Post by bjt » Wed, Sep 22, 2021, 9:24 PM UTC

mullingitover wrote: post #285

bjt wrote: post #211

Earlier quoted context omitted.

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 pric…

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.

Not sure how you get reinventing the wheel from my comment.

What I described would move us in the direction of the countries you're talking about.

I have lived in the UK, and seen doctors through the NHS. I have bought cough medicine at the chemist, and no it was not state-funded. I have visited patients at NHS hospitals where you are one patient sharing a room with 20 others in the same ward. I have talked to people on the waitlist for months to get surgery.

I still think the UK system is better than ours in the US for urgent care. I don't want anyone to be financially ruined because of some unforeseeable accident or emergency.

But I maintain that "health care" is way too big a category to be absolutist about using or not using free market principles in it. There are parts of health care where markets do not make sense. There are other parts where they do.

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

#390

Post by learc83 » Wed, Sep 22, 2021, 9:28 PM UTC

danShumway wrote: post #381

learc83 wrote: post #374

Earlier quoted context omitted.

>Definitely not the norm though It most certainly is the norm when purchasing complex custom services. >A contractor will not however replace the framing and then charge me after the fact. They'll discover the rotten framing, inform me of the new conditions and the new price, and then let me decide. A good contractor will walk me through that process. If a surgeon could keep your chest open on an operating table whil…

> It most certainly is the norm when purchasing complex custom services. An x-ray is not is not a complex custom service. > But how much is that worth when the entirety of the hospital visit is going to be a variable cost? This is the exact same argument that hospitals used to use against itemized pricing, and yet it turns out that requiring hospitals to give itemized bills on request has pretty solidly been a good t…

>Most health visits, and the vast majority of all preventative care, does not fall into that category.

The kinds of easy issues you're talking about don't need to happen in a hospital. You can already go to an outpatient imaging clinic for an x-ray, a dermatologist's office to have a mole removed, or an urgent care to suture a laceration.

If you need emergent care or you want an elective procedure that requires a hospital stay, you're into the realm of custom services with variable pricing.

>This is the exact same argument that hospitals used to use against itemized pricing, and yet it turns out that requiring hospitals to give itemized bills on request has pretty solidly been a good thing for consumers.

Has it? Has it driven down prices? Has the demonstrated value been worth the cost? Or has it just pushed hospitals into creating longer bills with more creative items and charges. Creative line items like $500 for aspirin perhaps?