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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

#431

Post by charlieflowers »

gameswithgo wrote: post #399
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.

Excuse me. But fucking cunt asshole motherfuckers, we should be lining the people who are intentionally deceiving the public up against the wall, they are causing people to DIE.

The most sane comment here, sadly.

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

#433

Post by golemiprague »

paulddraper wrote: post #428
satronaut wrote: post #189

Earlier quoted context omitted.

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,…

> You're in charge of saving lives but you can't handle something as standard as cost estimation. The irony, coming from a profession which is notoriously bad at cost estimation. But in any case, the difficultly is not so much the materials/services as much as figuring out what the patient's insurance company (which is completely different then the practice) will cover and by how much. But of course that's actually w…

But we are not asking for how much the insurance is going to pay, this is between a person and their insurance companies, we want to know how much the procedure cost, a simple price list.

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

#434

Post by dpayonk »

leetcrew wrote: post #26
dpayonk wrote: post #3

There is obviously a ways to go to create a system where price transparency is feasible, but I’m very interested in how the community might think it would affect the value based healthcare industry with respect to total cost of care management and bundled services? You cannot always look at a service in isolation because of complications on episodes like joint replacements or the impact of chronic conditions over the…

sure. any given procedure has a happy path and many different ways it could go wrong and become much more expensive. you can't really predict what it will cost for an individual. but after performing the same procedure hundreds or thousands of times, the hospital ought to be able to figure out a standard rate that (statistically) covers its costs. I don't see a good reason why a large organization with tons of cashfl…

This is what bundled payments are attempting to accomplish. These bundles take into account the procedure (cot codes) in addition to transmissions and rehab costs generally. Disclaimer: not an expert on this specifically.

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

#435

Post by refurb »

snarf21 wrote: post #155
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.

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 is what other countries with large well functioning private systems (Netherlands, Germany, Switzerland) do - they set reference prices that generously cap the costs that can be charged.

What people don’t understand is the appetite for healthcare spending is practically limitless - there is always something more you can do even if the benefit is marginal. As such you have to control spending somehow and the options are (not exhaustive):

- ration care by capping total healthcare spending - “we will do 1,000 hip replacements this year, everyone else waits”

- make the cost visible to patients so they ration their own care - Singapore does this even in their public system. There is no free care, you are expected to pay something according to your ability. This is what the US is trying to do with the move to HDHPs

- closely regulate coverage and prices. Many systems do this.

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

#436

Post by dpayonk »

peterangular wrote: post #216
nradov wrote: post #135

Earlier quoted context omitted.

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 a…

Bundled payments still help stablize the cost for an outcome. The bundled payment should make it easier to purchase a “knee replacement” as a consumer because you won’t need the clinical knowledge to understand the professional details of how. It has downsides as you mentioned above, but it can make consumer choice easier. Complexity is one of the fundamental challenges of paying for healthcare today.

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

#437

Post by toomuchtodo »

OrvalWintermute wrote: post #377
nradov wrote: post #326

Earlier quoted context omitted.

Medicare reimbursement levels are sufficient to support most medical practices. They charge more because they can, not because they have to. If reimbursement levels are cut then they'll find ways to improve efficiency, and then cut salaries. Is there a reason that US doctors should get paid significantly more than their peers in other developed countries? https://www.medscape.com/slideshow/2019-international-compen..…

> Medicare reimbursement levels are sufficient to support most medical practices. Big Nope. Most practices have fairly fixed costs: Medical malpractice Facilities rent, or mortgage Front office IT & EMR Privileging/Credentialing Practice CME/required education The only highly variable cost is physician compensation, and considering the limited availability, this will merely cause the retirements and limited access to…

> there is a limited supply of physicians

If the AMA isn't going to fix the physician and residency pipeline, could we not offer visas to physician immigrants who meet first world medical credentialing standards to deepen the supply and therefore support demand? If supply is the issue, we should fix the supple, not destroy necessary demand.

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

#438

Post by nradov »

toomuchtodo wrote: post #437
OrvalWintermute wrote: post #377

Earlier quoted context omitted.

> Medicare reimbursement levels are sufficient to support most medical practices. Big Nope. Most practices have fairly fixed costs: Medical malpractice Facilities rent, or mortgage Front office IT & EMR Privileging/Credentialing Practice CME/required education The only highly variable cost is physician compensation, and considering the limited availability, this will merely cause the retirements and limited access to…

> there is a limited supply of physicians If the AMA isn't going to fix the physician and residency pipeline, could we not offer visas to physician immigrants who meet first world medical credentialing standards to deepen the supply and therefore support demand? If supply is the issue, we should fix the supple, not destroy necessary demand.

The AMA isn't responsible for the bottleneck in residency slots. We should be asking Congress to increase funding.

https://www.ama-assn.org/press-center/press-releases/ama-fun...

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

#439

Post by Olreich »

mwerd wrote: post #355
callmeal wrote: post #255

Earlier quoted context omitted.

>You're making the reasonable-sounding (but incorrect) assumption that the cost to the hospital of a drugs is the same for every patient. Why shouldn't it be? How hard is it for a hospital to project their annual aspirin/paracetamol/? usage and budget for it?

Easy. Now try it at a rural critical access hospital for rattlesnake antivenom with a short shelf life, so it usually expires unused. They are required by law to stock it or they cannot have their emergency room open. Estimate the revenue generated from treating the one patient who needs it every other year, and by the way, you have 9 contracted payers with different rates and you don't know which one, if any, the pa…

So one patient every two years needs one dose of an antivenom. Charge them for the dose of antivenom. Then add up the unused stock as administrative cost and spread that over all emergency care. Simple and effective.

Do the same sort of thing for all other short-half-life things that you must keep on hand.

It doesn’t have to be hard. I get that it is complicated right now, but let’s focus on the idea that simplifying it would help everyone.

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

#440

Post by toomuchtodo »

nradov wrote: post #438
toomuchtodo wrote: post #437

Earlier quoted context omitted.

> there is a limited supply of physicians If the AMA isn't going to fix the physician and residency pipeline, could we not offer visas to physician immigrants who meet first world medical credentialing standards to deepen the supply and therefore support demand? If supply is the issue, we should fix the supple, not destroy necessary demand.

The AMA isn't responsible for the bottleneck in residency slots. We should be asking Congress to increase funding. https://www.ama-assn.org/press-center/press-releases/ama-fun...

I stand corrected. Thank you for pointing out my mistake.
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