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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

#291

Post by peteradio »

junofan wrote: post #201
ineptech wrote: post #194

Earlier quoted context omitted.

> Everyone is deathly afraid of making too many changes too fast because when those systems break the money stops flowing and a health system will literally go insolvent. Isn't this the desired outcome, that such organizations go broke? And let their assets, employees and customers go to some other organization that isn't saddled with technical debt?

The code looks like this: ``` I X?1.N1"H" S X=X 3600,%H=$H,@("X=$P(%H,"","",2)"_Y_X),%=$S(X 2-1 I @("%I(1)*100+%I(2)"_$E("> I mean, I can see why reimplementing could be scary even with org churn.

Binary looks like this 010100101001010 or something, surely the task of writing a mumps parser is long done?

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

#292

Post by KoftaBob »

diob wrote: post #165
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…

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.

A common thing many tend to misunderstand, is that there's a difference between a free market, and a competitive market.

The most competitive/efficient markets generally need the optimal amount of regulation to keep/get them that way. Those regulations would ensure that these conditions continue to be met in order for it to be a competitive market: https://en.wikipedia.org/wiki/Perfect_competition#Idealizing...

Free markets that are completely unregulated will tend to veer towards collusion and monopolies, in which case they're no longer competitive and the customers suffer. Free markets that are overly regulated will also suffer, but more-so due to things like the regulatory burden/barriers for new entrants.

What we have in the US healthcare system is a demented hybrid where some parts are free market but under-regulated, while other parts are free market but over-regulated. It's the worst of free market and state-run combined.

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

#293

Post by pc86 »

com2kid wrote: post #151
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…

> For the hospital to send them directly to another hospital would literally take weeks (at a minimum) of back and forth between two overworked and incompetent IT teams. Last time I had imaging done, my doctor gave me a list of nearby imaging services, and the one I selected was able to electronically send files back to my doctor. Heck I've witnessed my old dentist send x-rays over to my new dentist, it took like 5 m…

I can't speak at all to dental stuff as I've never worked with it. But to your first point, that's sort of expected - they're on a list already, the access has already been configured. They've already gone through all the nonsense.

The point is to send it to any arbitrary doctor they've never spoken to before, which requires offline media.

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

#294

Post by pirate787 »

el_jay wrote: post #238
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, thank you. One remark: > Modernization is hard, time consuming and very expensive. These regulations are a good driver for all that, but it takes time. Having been in some of these boardrooms there is not typically a cartel of evil executives figuring out how to screw patients. A lot of the time it is a group of relatively normal people trying to hold up a technological and business process house of card…

The system's complexity is a feature, not a bug. Regulatory capture is real. And much of the regulatory system in health care exists to limit competition. The AMA is a cartel of doctors that limits degrees even for qualified candidates. and the hospitals also operate as geographical cartels.

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

#295

Post by wefarrell »

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…

"There are some bad actors, absolutely true. However 'Hanlons Razor' -- never attribute to malice that which is adequately explained by stupidity -- definitely applies."

In healthcare especially incompetence opens the door for bad actors to exploit weaknesses in the system which amount to huge amounts of money being wasted. Medical fraud, for example, is one of the most sophisticated organized criminal activities in the United States. Mafias setup hijack doctors offices and pharmacies (or setup fake ones) and they know exactly how long it will take until they get caught. In the meantime they can extract tens of millions of dollars from insurance companies in fake claims.

And the fraud pales in comparison to the blatant waste. Doctors office's who order unnecessary CT scans when they or their affiliates happen to own a CT scanner. Pharmaceutical companies who market brand name pills that are no more effective than generics. Insulin manufacturers who manage to charge $1,000 a month for a product that's over a hundred years old.

In the case of pharma specifically, there are a lot of pricing inefficiencies that are deliberately not corrected due to political corruption so that they can be exploited.

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

#296

Post by symlinkk »

mushbino wrote: post #195
zrail wrote: post #94

Earlier quoted context omitted.

Was retroactively electing cobra not an option for some reason?

Longer story, but the timing of the emergency and recovery period fell within an ineligibility window for COBRA. My previous insurance company wouldn't have covered it anyway. It was the worst Blue Shield plan that I didn't even know could be legal. Also, I got the first few bills, was like okay, I'll just pay these off and move on and not even bother. These were the only bills I could find in their patient portal at…

What ineligibility window are you talking about?

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

#297

Post by pirate787 »

twicetwice wrote: post #188
throw123123123 wrote: post #175

Earlier quoted context omitted.

> 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.

This has been well understood in policy circles. The problem is that the employer insurance payment is tax deductible. This subsidy, along with scale, locks people into employer-based care through insurance. The Obama administration attempted to reform this by reducing the deduction on "Cadillac" health care plans but even that modest reform has since been scraped. (Insurance companies framed it as a "tax increase" when really it was closing a loophole.)

https://www.cigna.com/employers-brokers/insights/informed-on...

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

#298

Post by tomrod »

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…

I don't think vendor lock-in is a sufficient explanation here, respectfully.

I feel this is why efforts like FHIR are very important, though certainly scratching the surface.

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

#299

Post by formerkrogemp »

ransom1538 wrote: post #156
formerkrogemp wrote: post #126

Earlier quoted context omitted.

COBRA is fuxking expensive. I have no desire to pay for it again on a low salary.

Sigh. This isn't your fault. But COBRA is retroactive. EG. You have 60 days to find new insurance with a new employer. So you don't have to ever pay for COBRA. IF / when something happens - you pay all the missed bills and you are covered. That is the entire point of COBRA. People paying for COBRA are using it wrong or can't find employment in 60 days.

> So you don't have to ever pay for COBRA.

Not technically true when I used it last. I did have to pay for it.

"Employers may require individuals to pay for COBRA continuation coverage. Premiums cannot exceed the full cost of coverage, plus a 2 percent administration charge." But yes, the American Rescue Plan act allocated funds to make COBRA free. I wouldn't doubt that I was using cobra wrong at the time either prior to the passage of the act. Small pdf warning: https://www.google.com/url?sa=t&source=web&rct=j&url=https:/...

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

#300

Post by CarbonCycles »

lowercased wrote: post #288
jamra wrote: post #218

Earlier quoted context omitted.

I was in the physical therapy space for over 15 years. The penny pinching that comes from healthcare giants towards their software vendors are dreadful. It prevents any serious software engineering from happening. One customer billed over a billion dollars in a year to Medicare through our software and paid us $1M that year. I'm still not certain that we didn't take a loss to take that client. Passing around financia…

> Passing around financial data on SFTP drops is something that irked me. I see this a moderate amount in fintech, or perhaps at least older fintech? Had a colleague tell me about a new financial info provider he was supposed to connect with for data. "Oh this one will be easy" he was told. "They use oauth". OK... well... you oauth in, then you hit an endpoint that triggers a data build which then puts your data file…

No, I also see this in InsurTech. These companies are so deathly afraid of data breaches and system compromises that anything remotely modern frightens them...sadly.

And btw, that description given by your colleague brought cringy mental flashbacks on meetings I've recently attended.

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