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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

#331

Post by tunap »

IG_Semmelweiss wrote: post #322
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…

While what you are saying is all true, in general terms, but the key story seems missing: The "top of the funnel" system is very much fighting to preserve itself. - Insurance companies are in bed with hospitals to collaborate swindling money from the govt: read about kickbacks sent by the US Govt to hospitals as Disproportionate Share Hospital payments. - Hospitals have a PR arm moving profits to defend their monopol…

All valid, but you forgot another big story, for another day: "medical billing". This, in my minimally-informed opinion, is the syndicate keeping the fence running. I've had dealings with 4 owners of separate small-to-moderately sized billers and their top-brass all owned > 1 multi-million dollar homes around the world. Also, their toy boxes contained millions in cars, boats & flying machines. It must be nice, but incompetence doesn't smell right.

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

#332

Post by pc86 »

Symmetry wrote: post #328
pc86 wrote: post #144

Earlier quoted context omitted.

I've worked with many, many hospital IT departments as a consultant, contractor, and vendor. It's absolutely stupidity.

From a doctor compaining about the difficulties faced by generic alternatives to EpiPens: If you know anything at all about doctors, you know that they have way too much institutional inertia to change from writing one word on a prescription pad to writing a totally different word on a prescription pad, especially if the second word is almost twice as long, and especially especially if it’s just to do something silly…

I thought that most of the time pharmacists were empowered to substitute generics where comparable/available?

I generally have a pretty high opinion of physicians, but they are incredibly overworked, and typically just lazy enough for this quote to be more true than we probably think it should, especially with e.g. 20 years of history writing a specific word for a specific diagnosis.

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

#333

Post by Symmetry »

pc86 wrote: post #332
Symmetry wrote: post #328

Earlier quoted context omitted.

From a doctor compaining about the difficulties faced by generic alternatives to EpiPens: If you know anything at all about doctors, you know that they have way too much institutional inertia to change from writing one word on a prescription pad to writing a totally different word on a prescription pad, especially if the second word is almost twice as long, and especially especially if it’s just to do something silly…

I thought that most of the time pharmacists were empowered to substitute generics where comparable/available? I generally have a pretty high opinion of physicians, but they are incredibly overworked, and typically just lazy enough for this quote to be more true than we probably think it should, especially with e.g. 20 years of history writing a specific word for a specific diagnosis.

In this particular case EpiPens are protected from substitutions: https://abcnews.go.com/Health/epipen-users-options-generic-a...

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

#334

Post by hwillis »

zarzavat wrote: post #251
stevage wrote: post #82

>Require a standard format. Pick JSON or CSV in some standard encoding. We don't need hospitals publishing XML files and Excel spreadsheets. Definitely CSV. Always CSV. It's easy to produce, easy to parse, and kind of human readable. And easy to do some basic analysis with tools that everyone has access to - Excel, Google Sheets etc.

You cannot require CSV as a standard format because CSV itself has no standard. There are multiple variants of CSV and there's no way for a CSV file to declare which variant it's using in a standard way, which means you have to manually check that every single file parsed correctly, because if you accidentally parse a CSV file as the wrong variant there is no way for the parser to know and it will just silently corru…

> Sometimes CSV files themselves are ambiguous because they don't use any quoting so you end up with some lines that have more columns than others, and require manual repair line-by-line by a human.

It's wild that we haven't just started using unicode and line/group separator characters for tabular data instead of csv/tsv. Whoever decided to use a common semantic character as syntax is an evil, devious bastard.

That said, there is one thing I like about CSV and similar formats: they are inherently tabular. You don't have to worry about someone adding sub-objects to your JSON (or replacing a primitive field with an object/array). Extra columns are brainless to add or process, but converting sub-data to a line is not.

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

#335

Post by IG_Semmelweiss »

tunap wrote: post #331
IG_Semmelweiss wrote: post #322

Earlier quoted context omitted.

While what you are saying is all true, in general terms, but the key story seems missing: The "top of the funnel" system is very much fighting to preserve itself. - Insurance companies are in bed with hospitals to collaborate swindling money from the govt: read about kickbacks sent by the US Govt to hospitals as Disproportionate Share Hospital payments. - Hospitals have a PR arm moving profits to defend their monopol…

All valid, but you forgot another big story, for another day: "medical billing". This, in my minimally-informed opinion, is the syndicate keeping the fence running. I've had dealings with 4 owners of separate small-to-moderately sized billers and their top-brass all owned > 1 multi-million dollar homes around the world. Also, their toy boxes contained millions in cars, boats & flying machines. It must be nice, but in…

Medical billing is by a product of government mandates on insurance to cover everything + medicare and medicaid.

Make those programs go away, and CPT codes would eventually die.

It is not going to go away so unfortunately we need to learn to live life with it, and instead make it irrelevant, or niche, just like a ferrari is niche.

The best way to cope is to have an alternative to CPT coding, which means, alternative to insurance-based healthcare, which means, medicine between patients and doctors.

The only way to do that is that insurance and CPTs get so expensive that an alternative system is demanded by the market.. and people opt in (and regs allow for it). In effect, ferraris vs corolla. Corollas don't care about CPTs, Medical Billing, Eligibility, Copays, Coinsurance, or Authorizations.

The only way we can get more honda's is by having more independent doctors and less hospitals.

Hospitals create monopolies, independent doctors break monopolies with competition.

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

#336

Post by hwillis »

ars wrote: post #128
majormajor wrote: post #57

Earlier quoted context omitted.

Trump's administration offices finalized the rules on how it would work, but the law was part of the Affordable Care Act, so it would be the Democratic congress and presidency of the Obama era. Per https://www.sihd.org/affordable-care-act-price-list-2718-e and others One wonders what took so long, of course.

Not exactly: In 2019: "Specifically, we updated our guidelines to require hospitals to make available a list of their current standard charges via the internet in a machine-readable format and to update this information at least annually, or more often as appropriate." [1] Which is part of this executive order that Trump signed: "Within 60 days of the date of this order, the Secretary of Health and Human Services sha…

> (e) STANDARD HOSPITAL CHARGES.—Each hospital operating within the United States shall for each year establish (and update) and make public (in accordance with guidelines developed by the Secretary) a list of the hospital’s standard charges for items and services provided by the hospital, including for diagnosis-related groups established under section 1886(d)(4) of the Social Security Act.

Signed 2010, PATIENT PROTECTION AND AFFORDABLE CARE ACT. Sure sounds like Obama did it and not Trump.

http://housedocs.house.gov/energycommerce/ppacacon.pdf

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

#337

Post by bioemerl »

tunap wrote: post #331
IG_Semmelweiss wrote: post #322

Earlier quoted context omitted.

While what you are saying is all true, in general terms, but the key story seems missing: The "top of the funnel" system is very much fighting to preserve itself. - Insurance companies are in bed with hospitals to collaborate swindling money from the govt: read about kickbacks sent by the US Govt to hospitals as Disproportionate Share Hospital payments. - Hospitals have a PR arm moving profits to defend their monopol…

All valid, but you forgot another big story, for another day: "medical billing". This, in my minimally-informed opinion, is the syndicate keeping the fence running. I've had dealings with 4 owners of separate small-to-moderately sized billers and their top-brass all owned > 1 multi-million dollar homes around the world. Also, their toy boxes contained millions in cars, boats & flying machines. It must be nice, but in…

If your incompetence continually makes you money you aren't incompetent, you're malicious.

Courtesy of Louis Rossman, possibly stealing the quote, speaking about governments screwing up their fines and regulations.

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

#338

Post by sl-dolt »

joshgel wrote: post #280
sl-dolt wrote: post #164

I'm as surprised as anyone to see this #1 on HN. Glad y'all like it. AMA. Feedback, criticism, comments, directions to go, whatever.

> You have to hope your hospital uses CPT codes and not, say, DRG coding, or something else entirely, otherwise you'll need to look up those codes too. This is a bit of a misunderstanding. CPT codes are part of professional services billing, while DRGs are exclusively for inpatient acute care billing. If you are admitted to a hospital, you’ll probably have to deal with both.

That's a great piece of information that I'd have never known about without an insider telling me. So thanks!

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

#339

Post by sl-dolt »

microSnowball wrote: post #281
sl-dolt wrote: post #164

I'm as surprised as anyone to see this #1 on HN. Glad y'all like it. AMA. Feedback, criticism, comments, directions to go, whatever.

re the CPT codes-- 27486 and 27487 are for total knee revisions, not for a first-time replacement. 27486 is used if you only revise 1 component (ie the femoral side or the tibial side). 27487 is billed when both components are revised.

Thank you! I appreciate the correction, and this exactly shows how challenging it is for the average consumer to actually use these chargemasters in the first place to do their own research.

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

#340

Post by theossuary »

IG_Semmelweiss wrote: post #322
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…

While what you are saying is all true, in general terms, but the key story seems missing: The "top of the funnel" system is very much fighting to preserve itself. - Insurance companies are in bed with hospitals to collaborate swindling money from the govt: read about kickbacks sent by the US Govt to hospitals as Disproportionate Share Hospital payments. - Hospitals have a PR arm moving profits to defend their monopol…

Why are DSH payments bad?
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