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I analyzed hospital price lists so you didn't have to

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Re: I analyzed hospital price lists so you didn't have to

#181

Post by zxexz »

solumos wrote: post #149
pc86 wrote: post #142

Earlier quoted context omitted.

Hospital IT systems are incredibly locked down, especially from a network perspective. And DICOM images (the format things like x-rays are stored in) are very large, and not readable by most image readers. I honestly don't know if there are even free DICOM readers out there, but there probably are. CD is honestly the easiest way for them to send the images to you, because you can give them to any doctor and they can…

There are multiple free DICOM readers, but each imaging device manufacturer has its own interpretation of what a "DICOM" file is, so there are a lot of quirks.

I've worked with DICOM files from at least 10 different sources. I was able to eventually parse/view all of them. I seem to remember trying almost as many open source libraries in the process, however. That's one of the many problems in healthcare - even the standards have competing standards.

Re: I analyzed hospital price lists so you didn't have to

#182

Post by cycomanic »

robocat wrote: post #137
legitster wrote: post #49

A chain of clinics recently opened in our area that post all of their prices online. We almost exclusively go there now for everything. Even if they are occasionally more expensive (briefly, until the normal UC would send their surprise bills), it's just so much easier to pay up front. Thankfully we have an HSA and it's our money.

HSA for those who are “international”: https://en.m.wikipedia.org/wiki/Health_savings_account

That's insane! Goes to show again that the solution in the US is "be rich" and then you'll be given additional benefits.

Re: I analyzed hospital price lists so you didn't have to

#183

Post by mushbino »

rrdharan wrote: post #87
mushbino wrote: post #83

Earlier quoted context omitted.

Not just if you have money. If you have a lot of money. The majority of the country is one major accident away from being completely wiped out. It's the number one cause of bankruptcy. I had an emergency this year within a very tiny insurance gap between employers and now all of my savings and retirement are gone. I'm really not sure who it works out better for versus universal healthcare, but I can't imagine it's a…

You weren’t able to use COBRA? Or was the coverage just very poor even with it? My probably naive understanding was that COBRA can be activated retroactively if you get in an accident during the coverage gap.

Yeah, I tried all of that. I'll spare you the details, but things just lined up in a way that made me ineligible for COBRA, but the insurance that I had at my previous employer was absolute trash and they wouldn't have covered a single thing anyway. It was the only option given aside from Kaiser (my Kaiser saga is an even longer story), and even before this emergency it covered almost nothing.

My prescriptions seemed kind of high so I checked with GoodRx and they were cheaper! Cheaper without insurance than with, like how does that even make sense?

Right now I'm trying to negotiate on my last and only unpaid bill, the hospital won't negotiate with 1st parties so I've been trying to go through a newer company called Goodbill or something. I can't vouch for them yet as it's still in process, but just trying to get this all out of the way so I can just move on. Honestly, this whole thing has been so terrible that I'm just like, nope you're not even going in the worry pile. I'll go through the motions, pay it as best I can, and move on. I'll save the worry for the next totally normal work meeting coming up :)

I'm just very fortunate that I don't have a family to support or a mortgage to pay, even though I've been very close to breaking my lease and moving in with my parents until I can get back on my feet. I mean, I make good money too, I never thought I'd be in this situation.

I will absolutely go through the insurance options with a fine toothed comb when I interview again. Mama mía, aye yay yay

Re: I analyzed hospital price lists so you didn't have to

#184

Post by ellisd »

rrdharan wrote: post #87
mushbino wrote: post #83

Earlier quoted context omitted.

Not just if you have money. If you have a lot of money. The majority of the country is one major accident away from being completely wiped out. It's the number one cause of bankruptcy. I had an emergency this year within a very tiny insurance gap between employers and now all of my savings and retirement are gone. I'm really not sure who it works out better for versus universal healthcare, but I can't imagine it's a…

You weren’t able to use COBRA? Or was the coverage just very poor even with it? My probably naive understanding was that COBRA can be activated retroactively if you get in an accident during the coverage gap.

Fun Fact: COBRA coverage doesn’t exist when your startup shuts down and you’re laid off.

This did not stop my insurance company from cashing my premium payments for over three months, even though they silently canceled my policy (no email, mail, or phone call). I only learned I had no coverage when I actually tried to have a dental appointment. Refunds of these premium payments took another another 3 months to be returned!

Re: I analyzed hospital price lists so you didn't have to

#185

Post by curiousgal »

ls15 wrote: post #176
cgb223 wrote: post #38

Earlier quoted context omitted.

I wonder if one could automate finding the hospitals that don’t do this and filing a complaint that leads to a fine like patent trolls for a cause

The competitors that do publish the data have a reasonable interest in that, so I would expect this to happen.

The fact that we're talking about "competitors" in the context of hospitals whose job is to save lives is incredibly broken as a non-american.

Re: I analyzed hospital price lists so you didn't have to

#186

Post by twicetwice »

throw123123123 wrote: post #173
diob wrote: post #165

Earlier quoted context omitted.

The irony of attributing the free market healthcare disaster we have here to regulation. Things are plenty regulated in Australia and other socialized countries and they have none of the crazy billing / coverage issues we have. It's frankly, bullshit.

It's not the same regulation.

Yeah. A lot of flamewars have happened: "regulation bad!" vs "no, regulation good!".

But in reality, good regulation is good, and bad regulation is bad.

It sounds silly written out because it's a tautology, but if more people internalized it we could have much more productive conversations. Instead of going back and forth on whether regulation is good or bad, we should try to figure out which regulations are good and which are bad, and then try to get rid of the bad ones and pass more of the good ones.

Re: I analyzed hospital price lists so you didn't have to

#187

Post by BeetleB »

gavinray wrote: post #153
duffpkg wrote: post #65

Wrote Hacking Healthcare for O'Reilly, created ClearHealth/HealthCloud open source EMR, managed health systems for 15+ years, blah, blah, blah. It is very good there is are the transparency regulations. It is worth briefly explaining some of the reasons why many facitilities are having a hard time complying. There are some bad actors, absolutely true. However "Hanlons Razor" -- never attribute to malice that which is…

Interesting to read mention of MUMPS I'd never heard of it -- until I was at an afterparty at last year's AWS ReInvent and started talking to an older couple near us over some drinks. The guy was well to do and had been in technology a long time. We had a great discussion where he told me about things like MUMPS and other tech I'd never heard of. When they left, his wife gave me his name. Looked him up, it turns out…

Back when I was leaving school and looking for a job, I came across Epic and MUMPS.

From what I read, MUMPS is actually very performant. Although other companies use it, Epic is the giant. Epic was considered a decent company to work at - good reviews, good work/life balance. The downside is mastering technologies that no one else would value. Or so everyone thought. The reality was that if you become well versed in MUMPS and the Epic stack, a lot of hospitals would pay good amounts of money to you - a lot more than what Epic paid.[1] The only catch was that Epic had a 1 year non-compete clause.

At the time I considered them, they were starting to develop stuff with Visual C++ and .NET, so there was a chance you'd learn more transferable skills.

Fun story: The first time I encountered them at a career fair, I knew nothing about them. I was a grad student. At the booth, they asked me my SAT and GRE scores and were crazy impressed, and immediately booked me for their "entrance exam". At the time (perhaps even now), all candidates had to do a written exam - they'd arrange for the university to conduct it. The exam was mostly assessing logical skills, etc. No advanced material.

I didn't know anything about Epic at the time, and was extremely turned off by anyone being so easily impressed by things like SAT scores. I didn't bother to go through with it. I was studying an advanced degree, and wanted to work for a place that was not so superficial.

Fast forward a semester later when I really needed a job. I researched Epic and it actually didn't feel so bad. I felt I would easily ace their logic exam. So I applied to them. This time, though, they made me do an online behavioral screen first. The type where they ask questions like "Are you more of a X or Y?" where you feel you're neither X nor Y. Apparently I flunked that test and they didn't invite me to take the logic test. Bummer.

[1] Not FAANG level money, but still a lot more than industry average, and a relatively cushy job with you being treated as "the expert".

Re: I analyzed hospital price lists so you didn't have to

#188

Post by twicetwice »

throw123123123 wrote: post #175
smolder wrote: post #160

Earlier quoted context omitted.

The difficulty of fixing and improving these systems is frankly overrated. It has more to do with penny pinching and profiteering that they haven't modernized. I don't mean a rewrite in JavaScript either, I mean sensible engineering, which many people are ready to do but not paid to do, because it weakens the upwards money vacuum the finance cabal wants to maintain. Progress isn't profitable enough according to the E…

> Progress isn't profitable enough according to the Excel spreadsheet. It's precisely the opposite. Its a racket but its not for profit. If you made a health care service that didn't have any of this cruft and just provided great care, it would not be used, because it would not be compliant with insurance, and employees would not get the tax benefit of using it. If it were for profit, it would work better.

Yes, the fact that literally all health care goes through insurance is a big part of the problem. As my dad says, if you had to get all car maintenance done through your car insurance, changing your oil would cost $5,000.

Re: I analyzed hospital price lists so you didn't have to

#189

Post by BeetleB »

smolder wrote: post #160
duffpkg wrote: post #65

Wrote Hacking Healthcare for O'Reilly, created ClearHealth/HealthCloud open source EMR, managed health systems for 15+ years, blah, blah, blah. It is very good there is are the transparency regulations. It is worth briefly explaining some of the reasons why many facitilities are having a hard time complying. There are some bad actors, absolutely true. However "Hanlons Razor" -- never attribute to malice that which is…

The difficulty of fixing and improving these systems is frankly overrated. It has more to do with penny pinching and profiteering that they haven't modernized. I don't mean a rewrite in JavaScript either, I mean sensible engineering, which many people are ready to do but not paid to do, because it weakens the upwards money vacuum the finance cabal wants to maintain. Progress isn't profitable enough according to the E…

> The difficulty of fixing and improving these systems is frankly overrated. It has more to do with penny pinching and profiteering that they haven't modernized.

Eh, I'd rather listen to duffpkg, with his extensive, real world experience in health tech, than a random comment.

FWIW, a former coworker of mine spent a few years at a health technology company (also worked with MUMPS), and legal compliance was the number one hurdle to modernizing. It was expensive, and created a huge drag.

Re: I analyzed hospital price lists so you didn't have to

#190

Post by [deleted] »

jjoonathan wrote: post #104
JumpCrisscross wrote: post #51

Earlier quoted context omitted.

> the solution to most social ills in America is to simply not be poor American healthcare works well if you have money and better than anywhere else in the world if you have money and a chronic condition. If you get in an accident, however, particularly while away from your posh neighbourhood, you’re getting the same overworked, hyper-indebted surgeon as the homeless man. (If you’re a billionaire or head of state, t…

> better than anywhere else Spoken like a salesman! It's mostly false. Last time I did a deep dive on this, the US had a genuine but small edge in treatment for diabetes and breast cancer, but that was it -- and the edge was nowhere near proportional to price.

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