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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

#221

Post by ravel-bar-foo »

lotsofpulp wrote: post #115
dragonwriter wrote: post #88

Earlier quoted context omitted.

> If a huge chunk goes to retirees and wasn’t 40 years ago, there’s simply less leftover for everything else. If you are talking about state governments in the US, that's approximately true. If you are talking about the federal government, it's not, because the idea of a fixed purse is simply false. Spending and revenue are separate policy decisions that don't constraint each other.

I do not understand why you are downvoted. It is obviously true the federal government can simply issue new money to pay its debts.

It's true, but you get inflation or exchange rate devaluations as a side effect.

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

#222

Post by bsimpson »

pc86 wrote: post #142
bsimpson wrote: post #106

Earlier quoted context omitted.

I broke my foot recently. Calling around and asking for quotes ranged from a straight up "I don't know" to "Here is the cash price. We won't know your HDHP insurance price until after we bill them, which could be good for you or could be bad. It will probably be bad, because there are more middlemen." I tried paying the cash price. They inadvertently billed my insurance anyway. Turns out, I actually saved like 33% us…

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…

The weird thing is that there are signs all over the clinic about how they now have Athena Health for telemedicine.

Cool dudes. Have you considered letting me download the x-rays I just paid for from that portal?

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

#223

Post by vivegi »

A few routine billing concepts that skews line item amounts in raw claim dumps or price lists derived from claim dumps:

- CPT modifiers (The service or procedure has both professional and technical components OR More than one provider performed the service or procedure. More than one location was involved OR A service or procedure was increased or reduced in comparison to what the code typically requires etc.,)

- Bundling (1 line item as opposed to 2 or 3 when the second and third procedures are an outcome of the first. eg: bone-xray + procedure(s) to fix the broken bone detected through the x-ray)

- Rendering provider vs. Billing provider (Rendering provider is the physician or provider that provided the service and billing provider could be the hospital/clinic/lab/ambulatory/billing company etc.,)

But here's the kicker. Medicare is the largest payer in the US and it already has a Fee-for-service pricing schedule. You can be sure that it covers all states, locality-wise price adjustments, hospital density factors in the price schedule and every possible procedure billing scenario. So, one just needs to compare (within a ZIP code or County or other geographic area) the hospitals prices against this to find anomalous pricing issues.

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

#224

Post by markus92 »

Temporal_Trout wrote: post #147
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…

I'm not sure if "proper" DICOM files are different (DRM?) but during my undergrad I had a medical imaging class working with anonymized DICOM files and we used Pydicom (With Jupyter Notebook) to display the images and annotations: https://pydicom.github.io/pydicom/stable/index.html

There’s (luckily) no such thing as DRM in DICOM, but there is a billion ways to interpret the standard. Pydicom does work for the more common things but there’s some rare types of DICOM it unfortunately can’t handle.

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

#225

Post by bsimpson »

dheera wrote: post #112
bsimpson wrote: post #106

Earlier quoted context omitted.

I broke my foot recently. Calling around and asking for quotes ranged from a straight up "I don't know" to "Here is the cash price. We won't know your HDHP insurance price until after we bill them, which could be good for you or could be bad. It will probably be bad, because there are more middlemen." I tried paying the cash price. They inadvertently billed my insurance anyway. Turns out, I actually saved like 33% us…

I just got billed $5000 for a routine echocardiogram at Stanford, and in the process of fighting it. My insurance is supposed to cover preventative care 100% (not even a copay). They billed $18000 total (yes, for a 1-hour ultrasound) and insurance is leaving me to pay $5000. This is about the 6th time this has happened. It's always 15+ e-mails back and forth, then threatening lawyers, then they back off. I'm wonderin…

Medical billing is the worst.

I got a physical in Oct 2020, but the coronavirus spiked and it took me until April 2021 to go in and do the labs. One Medical screwed up the billing, coding them as diagnostic instead of preventative (or however that works).

I got nasty letters from both LabCorp and One threatening to send me to collections and ding my credit and all that. I'd text One and they'd be like "oh, just ignore those. We'll fix it." Months go by. "Just ignore them. We'll get to it."

It's such a massive what the fuck.

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

#227

Post by vineyardmike »

BeetleB wrote: post #187
gavinray wrote: post #153

Earlier quoted context omitted.

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…

> Epic was considered a decent company to work at

heard this is no longer the case with the pandemic. Apparently the CEO had some questionable perspectives on COVID for someone who managed health tech. None of my friends who had jobs there made it through covid without quitting or watching their team quit.

Anecdotally, their recruiting is a mess and the IQ test type interviewing is very common for them instead of FAANG style interviews. I reached out to them at a career fair and they laughed at me and told me I was unqualified because by resume said "medical engineering with a focus on software" and said they only wanted software engineering. That day I re-wrote my resume to say "CS with a focus on medical tech" (I was formally un-declared as a student at the time) and the same person who threw out my resume offered to interview me - I declined.

* I also would later graduate with a degree in computers not medicine, in large part due to that interaction, despite forming a very negative perception of that recruiters behavior.

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

#228

Post by refurb »

JumpCrisscross wrote: post #51
javajosh wrote: post #37

Earlier quoted context omitted.

>So I guess I should shop around by moving cities No, the solution to most social ills in America is to simply not be poor. If you are poor, stop it. Then you don't have to worry about any of this. Consider abortion, a procedure now outlawed in many US states. If you're not poor, you can just pay to travel to another state or country, have the procedure, do some sight-seeing, and come home. The law has no de facto ef…

> 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…

Disagree. A friend who had dual citizenship moved from Canada to the US because Medicaid covered her kids rare disease drug but Canada didn’t.

Medicaid is actually very good coverage.

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

#229

Post by refurb »

legitster wrote: post #48
briHass wrote: post #39

Earlier quoted context omitted.

> doctors prescribing named brand, and you not be allowed to switch back to generic without another $100+ appointment I'm not sure this is that common, unless you have an adversarial relationship with your doctor. It's actually the opposite: in most states the Dr. must write DAW-dispense as written or 'name brand only' to get the expensive brand. Otherwise, the pharmacist can and will substitute a generic if availabl…

Fun fact, your pharmacist is allowed to change your prescription in some states! Try asking them if there are cheaper generics.

In most states they don’t have to ask. A generic is equivalent substitute for the brand name.

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

#230

Post by namdnay »

danachow wrote: post #158
dheera wrote: post #112

Earlier quoted context omitted.

I just got billed $5000 for a routine echocardiogram at Stanford, and in the process of fighting it. My insurance is supposed to cover preventative care 100% (not even a copay). They billed $18000 total (yes, for a 1-hour ultrasound) and insurance is leaving me to pay $5000. This is about the 6th time this has happened. It's always 15+ e-mails back and forth, then threatening lawyers, then they back off. I'm wonderin…

> I am insured and it is preventative care How or why do you think an echo is preventative care? While insurance plans are free to define any additional menu of services as preventative - an echo is not included in the minimum set required by the federal government - which are procedures based off of US preventative services task force guidelines - there are no published guidelines that include an echo. I wish you lu…

There are two categories of healthcare right? Palliative and preventative. Which one would an echo be in this case? If he had violent symptoms it would clearly be palliative, but in this case it can only be preventative
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