151–160 of 171 posts
We should compel these companies to comply. There should be fine a 1% of annual revenue for every day these companies are in non compliance with prison for the ceo if they are non compliant for over thirty days.
I've asked the author for a copy of a correct csv or xlsx file, I'll share it if the author responds. https://imgur.com/a/bTmfDEU
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I'm pretty sure the truth is a mix of malicious compliance and inability, but I'd weight it heavily in favor of malicious compliance, especially for the insurance data. Insurers know their costs, and when and why they pay specific charges. (My qualifications to make this statement: 15 years in healthcare IT, including UHG/Optum, and 8 years as CTO of a large clinical organization that included primary through tertiar…
I'm not so confident from my experience in healthcare IT, admittedly shorter than yours. One of the issues seems very telling, the fact that one of the listed rates from the insurer matched the portion paid to the radiologist but not the total. Problems with matching up different line items are really ubiquitous in healthcare systems because, despite the standardization that theoretically exists, there's huge variati…
> Sure, insurance companies ultimately know what they paid
It came to mind reading the above that a more accurate/useful perspective might be "The insurance companies' system knows what they are paid," but those system may comprise multiple software systems, none of which have data in compatible formats.
Ergo, even though the insurance company "knows" operationally (it can generate a number on request), it might be unable to generate a list of all numbers (effectively: every path through the system).
But that's why mandates work in insurance: if CMS pushes hard enough, eventually the insurers will develop the functionality.
I've asked the author for a copy of a correct csv or xlsx file, I'll share it if the author responds. https://imgur.com/a/bTmfDEU
https://github.com/CMSgov/price-transparency-guide/tree/mast...
Along with this fantastic guide:
https://github.com/CMSgov/price-transparency-guide
I recommend them to anyone who wants to see good examples of price transparency.
Imagine a world where one entity received all the peoples medical bills and was incentived to negotiate for the lowest possible rate from each provider. Imagine the savings alone from reducing a massively overly bureaucratic and complicated system down to just one entity negotiating and paying the health service providers. Just imagine in that world this article would have never needed to have been written.
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"Never come between a man and his meal" playing out right here
Unfortunate that the man in this analogy is Hannibal Lecter (Silence of the Lambs, Hannibal is a violent psychopathic cannibal in that movie), and should be stopped from getting his meal. Insurance companies are a problem, and they've grown fat skimming a fair fraction of this nation's GDP for no observable value provided. Our healthcare system is more expensive and has on average worse outcomes than other first worl…
none of my colleagues believe it (they also don't believe in human caused climate change or that ectopic pregnancies are unviable, all sorts of nonsense)
I'm waiting until we meet that great filter in the sky
This could have been much much easier if they just required the medical equivalent of certificate transparency. Every insurance company is required to post publicly every single claim they receive, the full information of the provider(s), the name/code of the plan, the billing codes, whether it was approved or denied, how much the insurance was billed, and how much insurance actually paid (where paid doesn't mean dis…
Completely agree. There are databases like this out there (All-Payer-Claims database) but they're extremely expensive (it would cost millions to get data for the entire US) and I have no idea why.
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Companies can’t vote.
Companies are considered a person and legally have rights such as freedom of speech, can own property and enter contracts. They are allowed to spend as much as they want for votes due to their freedom of speech. Sure they can't directly vote but ever since like 2010 have a lot of human rights and I'm sure would love more. I would not be surprised if one day they could directly vote considering due to their rights. I…
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> but it's definitely eye opening just how malicious they made it As someone familiar with insurer, provider, and facility IT systems, I'd offer an alternate explanation -- the data is bad because healthcare IT is understaffed (and often incompetent). These are businesses that have squeezed most costs out, and IT is definitely a cost. Imagine banking... if there were much less competitive pressure and an inability to…
>> These are businesses that have squeezed most costs out, and IT is definitely a cost. What's the cost of an X-ray? Did you know they used to do a FREE X-ray at the shoe store back in the day to check fit? Yeah, don't tell me they squeezed out most of the cost.
American healthcare not a free market.