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A petabyte of health insurance prices per month

blog.turquoise.health

111–120 of 275 posts

Re: A petabyte of health insurance prices per month

#111

Earlier quoted context omitted.

Here's the full list of codes for "Bitten by ____, _____ encounter" https://www.icd10data.com/ICD10CM/Codes/V00-Y99/W50-W64/W61- The hierarchy looks like this: W61.6 Contact with duck = W61.61 Bitten by duck == W61.61XA …… initial encounter == W61.61XD …… subsequent encounter == W61.61XS …… sequela = W61.62 Struck by duck == W61.62XA …… initial encounter == W61.62XD …… subsequent encounter == W61.62XS …… sequela = W6…

But why? I could understand from a treatment perspective the type of animal mattering (but even then initial vs subsequent encounters?). From a billing perspective, wouldn't it make sense to have animal bite exam fee, with possible additional charges for bandaging, stitches, rabies shot, etc based on doctor's discretion?

It partly arises as a mechanism to pay per case, not just per visit. For example, if we put all payment for a breast cancer treatment into the first visit, there is now an incentive to either complete the treatment (ideal) or keep the patient from coming back (less ideal). You can use these follow-up codes to measure rates of return visits, which can be related to quality of care metrics.

Re: A petabyte of health insurance prices per month

#112

Earlier quoted context omitted.

Because, like it or not, a doctor's discretion can sometimes be self-serving. The more treatments a doctor gives, the more they get paid, and there is an enormous information imbalance between doctor and patient. (As in, they went to medical school, and you didn't.) Unfortunately, some doctors are willing to take advantage of this.

> The more treatments a doctor gives, the more they get paid You could say this 30 years ago, but it's not really the case today. The majority of physicians are now salaried, not independent. And even for many of the ones in independent private practice, the amount they make is not necessarily tied anymore to the services they provide, due to the rise of capitation and other forms of bundled service agreements. Nowad…

I would love to see some data on this, if anyone knows of any. I'll just provide anecdata that of the doctors among my friends and family, more of them get paid by "wRVU" [0], which is basically a derivative of "how much treatment you give", than by salary.

(I only happen to know this because they complain nearly incessantly about the wRVU system! I make no claim to be an expert on the topic.)

[0] https://www.physiciansthrive.com/physician-compensation/wrvu...

Re: A petabyte of health insurance prices per month

#113
The medical cartels need to be destroyed.

They are mathematically the most corrupt industry according to open secrets all time lobbying data.

Physicians are the richest profession in the US, and limit their supply by weaponizing the ACGME/AMA.

Hospitals/clinics make so much money. We own one, and while it was slow to start, the profits are insane. Marketing is the hardest thing, once a patient comes in the door (and they don't have medicaid) its pure profit. Don't let anyone in healthcare let you think margins are slim.

Pharma... we all know pharma.. (And pharmacists in 2023? Heck ML/AI will always be better than trusting that a pharmacist is on their game 100% of the time)

Insurance, I have no idea how they waste so much money and have slim margins. Anyway they are weirdly allies most of the time because they will adjust a $400 bill down to $125. But they also suck with how expensive premiums are... again. what the heck is going on with their slim margins? Maybe its their ultra fancy buildings.

Re: A petabyte of health insurance prices per month

#115
post #6

They are making it impossible to handle the data so everyone gives up trying so they can go on screwing people over.

Hanlon's razor. Never attribute to malice what can be explained by stupidity. The US healthcare system is a mess, but I don't think it's intentionally malicious. It is just a mash of a thousand different systems, creating one big stupid system.

[dead]

Re: A petabyte of health insurance prices per month

#116

The medical cartels need to be destroyed. They are mathematically the most corrupt industry according to open secrets all time lobbying data. Physicians are the richest profession in the US, and limit their supply by weaponizing the ACGME/AMA. Hospitals/clinics make so much money. We own one, and while it was slow to start, the profits are insane. Marketing is the hardest thing, once a patient comes in the door (and…

Aren't there laws that require insurance companies and utility companies to have specific margins? They could in theory just print infinite money so they need to be reigned in by governments.

Re: A petabyte of health insurance prices per month

#117
post #24

They're using information overload tactic. This approach leverages a psychological principle that suggests when people are given too many choices or too much information, they can become overwhelmed and struggle to make decisions. The point is to overwhelm, the consumer, the people trying to fix this system etc.

A simpler and more rational explanation, is that they're trying to overwhelm the adversary. The insurance company, its claims department. If you can't ever compare two medical treatments because they're never similar, let along identical, then any price at all might be attached to these. The consumer hands over a laminated card and says "I have insurance". No one's overwhelming him. He's not even really a party to th…

An even more rational explanation is that the human body is one of the most complex machines there is, and we barely have an understanding of it. Those who do have some understanding of it spend decades learning about it, and so a layperson will simply never have the expertise to make informed purchasing decisions.

That is why the insurance company (ideally) can serve as an informed agent (employing doctors and pharmacists), who (ideally) will more often than not know what is and is not worth paying for.

Re: A petabyte of health insurance prices per month

#118

The medical cartels need to be destroyed. They are mathematically the most corrupt industry according to open secrets all time lobbying data. Physicians are the richest profession in the US, and limit their supply by weaponizing the ACGME/AMA. Hospitals/clinics make so much money. We own one, and while it was slow to start, the profits are insane. Marketing is the hardest thing, once a patient comes in the door (and…

Aren't there laws that require insurance companies and utility companies to have specific margins? They could in theory just print infinite money so they need to be reigned in by governments.

Yes.

https://www.healthcare.gov/health-care-law-protections/rate-....

Re: A petabyte of health insurance prices per month

#119
post #79

There are separate charge codes for everything , and all of those codes need to be reflected in the pricing data. There's a price to slap on a bandaid. There's a price to give someone a Tylenol. Hell, W61.61XA is the medical code for "Bitten by duck, initial encounter." Presumably, this means there's also a code for "Bitten by duck, again." Medical billing is broken , and it's no surprise that the amount of data is o…

Ok, so it's _broken_. As a system of recording stuff is it also ... incoherent? Slapping on a bandaid or giving someone tylenol are _services_. "Bitten by duck" is a _cause_, and different people bitten by ducks could need different services, and people impacted by different causes could need the same services. If I have a laceration, I'm guessing that how I'm treated should depend on how deep/large/severe it is, rat…

Yes, the cause or problem is needed as well as the procedure or treatment that was delivered to treat the problem. The treatment will be charged separately for professional (like MDs) and technical (like nurse, pharmacy). It also matters who is performing a procedure. An MD slapping the bandaid charges more than a PA, Nurse Practitioner or PharmD.

https://www.icd10data.com/ICD10PCS/Codes

Re: A petabyte of health insurance prices per month

#120

Earlier quoted context omitted.

Here's the full list of codes for "Bitten by ____, _____ encounter" https://www.icd10data.com/ICD10CM/Codes/V00-Y99/W50-W64/W61- The hierarchy looks like this: W61.6 Contact with duck = W61.61 Bitten by duck == W61.61XA …… initial encounter == W61.61XD …… subsequent encounter == W61.61XS …… sequela = W61.62 Struck by duck == W61.62XA …… initial encounter == W61.62XD …… subsequent encounter == W61.62XS …… sequela = W6…

But why? I could understand from a treatment perspective the type of animal mattering (but even then initial vs subsequent encounters?). From a billing perspective, wouldn't it make sense to have animal bite exam fee, with possible additional charges for bandaging, stitches, rabies shot, etc based on doctor's discretion?

because CDC wanted to collect epidemiological data on how those bites were happening, instead of having single generic "animal bite" code. If there is a sudden rise in duck bites in a future decade, we can start asking about whether there's a reason behind that, or something we should be doing to control duck populations, or something. That's what CDC is there to do.

It's extraordinarily difficult to capture this information after the encounter... the patient is gone, the provider is working from notes/memory, and now it's this additional specific burden. How are you supposed to run an epidemiological study on the prevalence of duck bites if everyone involved has vanished into the ether? If you're going to capture it, it has to be rolled into the diagnosis codes and captured during the encounter. Also, you really want to capture the contemporaneous narrative including any misdiagnoses/etc - the CDC wants to know how much that is happening too!

really those low-level codes are kinda just there, they're not really used in practice, and most billing systems would care about the higher levels of the hierarchy anyway. The part insurance cares about is "cleaning and stitches after small wild animal bite", not the levels of the coding scheme that indicate that it's a duck bite.

(but you can see how it is potentially useful to shake some of these details out - is it a large animal, or a small one? a pet or a wild animal? a wild bear bite and a pet duck bite are two very different scenarios for the provider+insurer!)

It's also really more about things like "gunshot wound from stranger" vs "gunshot wound from partner" vs "gunshot wound from LEO" where there is obvious value in capturing what is going on. Jokes aside, nobody is super concerned about duck bites, it's just a funny example of how detailed the coding system can be (not must be... at least yet).

The real travesty is the idea that the same action using the same materials in the same facility can be billed 2 different ways based on two different ICD codes, not that ICD codes include the diagnosis data. It shouldn't matter if it's a duck or a cat, it's a superficial clean-and-bandage, that's what procedure coding (CPT) is supposed to capture. If there's major variations in how you perform a procedure based on how the patient presents, such that cost is substantially impacted... that is a deficiency in CPT and needs to be fixed independently, not forcing everyone to track CPT+ICD for eternity.

~~CPT itself incorporates a huge amount of nuance and sub-coding for this exact reason.~~ Simple example but we'd spit out CPT codes like "MRI with contrast-enhancer" vs "without", "MRI 3-tesla" vs "1.5T" vs "Open", "CT 64-slice" vs "40-slice", etc. If you're not capturing some aspect of the procedure you need to take it up with the CPT people, not make it everyone else's problem.

edit: superfun memory this just triggered, in fact this imprecision in CPT coding actually does lead to different things having the same CPT code and operators have to select from a picker of these possibilities that are specific to their organization's coding/billing systems. Forgot about that, awesome!

Medical data systems are the absolute worst

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