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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

#351

Post by nescioquid »

kibwen wrote: post #290
el_jay wrote: post #238

Earlier quoted context omitted.

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 richest country on Earth" This statistic is misleading. The US is only the richest country on Earth if you consider the mean wealth. By median wealth, the US is ranked 26th. The wealth gap is enormous, and if you're in the upper echelons of the pyramid your health outcomes are vastly better than the clownshoes shitshow that the rest of the country is subjected to.

The critique is perhaps not relevant here, since it suffices to say that the country's wealth can afford a health care system not held together by "spit and twine", irrespective of how that wealth is presently apportioned. The wealth gap is, as you say, enormous.

In fact, the wealth gap is but a reflection of the underlying cause of the problem: legislators corrupted to the interests of the donor class at severe cost to the actual constituents of those legislators.

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

#352

Post by stickfigure »

soco wrote: post #264
stickfigure wrote: post #242

Earlier quoted context omitted.

> It bears questioning how, in ”the richest country on Earth”, something as important as a hospital ends up held together with spit and twine. In less rich countries they use paper records, which are worse. Everything is held together with spit and twine.

There's a lot of this concept, that if it doesn't work in the US, everybody else must have failed even worse. Well, not really, many times it's actually the other way around. I won't bother with other more obvious examples but in this context, even Pakistan has a digital health system in the meantime.

My wife did part of her nursing program in St Kitts. They used paper records.

She also says that, of the half-dozen medical record systems she has used (here in the US), Epic is one of the better ones. (read: least bad)

I'm sure if you talked to medical professionals in Pakistan they would bemoan their medical record system too. It seems to be popular sport in the medical community.

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

#353

Post by JumpCrisscross »

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.

> US had a genuine but small edge in treatment for diabetes and breast cancer

You’re looking at gross statistics. On average, American healthcare is average. If you zoom into the top 10%, it outperforms other countries’ top 10% (in general; of course there are exceptions). This goes from virtually instant imaging with concierge medicine to the Cleveland Clinic’s global medical evacuation jets and helicopters.

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

#354

Post by JumpCrisscross »

mushbino wrote: post #183
rrdharan wrote: post #87

Earlier quoted context omitted.

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…

> hospital won't negotiate with 1st parties

Talk to an FCRA lawyer. There are certain notices that if you send them and they are ignored can let you remove the lines from your credit report should they mark them as defaulted on. They will likely also help if the hospital chooses to sue.

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

#355

Post by pc86 »

vlovich123 wrote: post #69
mgleason_3 wrote: post #7

Interesting to read that only 33%-50% of hospitals comply with the law and post their prices. If there's one thing this country needs to do it's demand transparency everywhere. Especially our government. Spending. Salaries. It all needs to be public.

What is the penalty for non compliance?

CMS just fined some hospital $900k. So it's not nothing.

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

#356

Post by pc86 »

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.

Might be a dumb question, but if I joint hospitals and prices, and filter to the couple nearby hospitals that I care about, and I get 0 rows, that means they're violating the transparency law, correct?

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

#357

Post by refurb »

consp wrote: post #234
refurb wrote: post #228

Earlier quoted context omitted.

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.

With rare diseases this is always the case. Here in NW Europe we have the same issue with some one in a million diseases. The main issue is the insane prices charged by the companies to recouperate in a few years time to appease shareholders instead of several decades, which results in the cold truth it is not worth the effort looking at the grand scheme of things.

That’s the thing. The US system is expensive not only due to inefficiency but also due to a willingness to pay for things other countries don’t.

If you happen to have a kid with a rare disease, that matters.

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

#358

Post by adolph »

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.

That is from VA Fileman, right? I did a "lite" replatforming a few years ago.

https://www.hardhats.org/fileman/pm/index.htm

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

#359

Post by Brystephor »

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 work in the payments and billing area for my company. So, this idea of medical billing being so out of date is interesting.

Can you share your insight as to why it is not something that smaller companies or starts up have tried to fix? You can also email me (email is my HN username at Gmail dot com). I'm interested in learning more about this on a technical/"behind the scenes" level.

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

#360

Post by nradov »

IG_Semmelweiss wrote: post #335
tunap wrote: post #331

Earlier quoted context omitted.

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…

The best way to cope is to shift provider compensation from a fee-for-service model to a value-based care model. That reduces the need to code individual procedures using CPT for billing purposes. This industry shift is already underway, but moving slowly.
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