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New health insurance “transparency data” looks suspiciously wrong

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Re: New health insurance “transparency data” looks suspiciously wrong

#121

Post by softsound »

sbaiddn wrote: post #75
christophilus wrote: post #66

Earlier quoted context omitted.

I live with private healthcare. The last few trips to the ER have been 8 hour waits, too. This is an under capacity thing. I live in a place that has boomed, and the mismanaged hospital hasn’t remotely kept up. They fired a bunch of folks during COVID, then shocked pikachu found themselves understaffed. The point is, the entire thing is broken nearly everywhere you look. I don’t know what a better alternative is, but…

I live in the US. Every trip to the ER has had 5). So you millage may vary.

ER visits really vary. In Austin, Texas you may be able to get in a few minutes to a few hours. Just really depends, when my mom when to the ER last year for extremely high blood pressure she had to wait half a day before she could she see anyone and they thought she might have a stroke. She was fine in the end, but if there was a real emergency I can't imagine what we'd do. I remember we went to the ER at like 4pm but it took until like 2am before she was able to get in and they decided to have her stay the day. I stayed up all night waiting for her to get help it was very stressful. Also what a joy of getting that bill literally a year later, you'd think they would have due dates of when they have to send these out!

Re: New health insurance “transparency data” looks suspiciously wrong

#122

Post by brewdad »

polygamous_bat wrote: post #51
avidphantasm wrote: post #20

So not only shouldn’t healthcare be a market good (moral argument), but healthcare profiteers are actively distorting the market and are not taking seriously efforts to provide a modicum of information to participants in this so-called market.

Can't really be a market with such obscure pricing and inelastic demand.

Even given inelastic demand, a market with open, easily available pricing would be freer and fairer than what we have today.

Re: New health insurance “transparency data” looks suspiciously wrong

#123

Post by sbaiddn »

brewdad wrote: post #115
sbaiddn wrote: post #75

Earlier quoted context omitted.

I live in the US. Every trip to the ER has had 5). So you millage may vary.

You either live in a miracle land where no one ever gets sick yet ER capacity remains high just in case or your child was on the verge of death. The last time I visited an ER with my child it took 10 minutes just to check in. Then a 2 hour wait to be seen.

Miracle land, and it's probably unsustainable. The hospital is large, but opened just over a year ago. My guess is that my neighbors haven't incorporated it into their routines.

Also, where I live there are five (?) Hospitals with ER within a ten minute drive... in suburbia. There just can't be that many people getting deathly ill sick.

Re: New health insurance “transparency data” looks suspiciously wrong

#124

Post by sbaiddn »

softsound wrote: post #121
sbaiddn wrote: post #75

Earlier quoted context omitted.

I live in the US. Every trip to the ER has had 5). So you millage may vary.

ER visits really vary. In Austin, Texas you may be able to get in a few minutes to a few hours . Just really depends, when my mom when to the ER last year for extremely high blood pressure she had to wait half a day before she could she see anyone and they thought she might have a stroke. She was fine in the end, but if there was a real emergency I can't imagine what we'd do. I remember we went to the ER at like 4pm…

"Also what a joy of getting that bill literally a year later, you'd think they would have due dates of when they have to send these out!"

I thought they do, in fact, and the bill expires if not sent out in time.

Re: New health insurance “transparency data” looks suspiciously wrong

#125

Post by softsound »

lazide wrote: post #101
ChrisMarshallNY wrote: post #87

Earlier quoted context omitted.

The difference is who the opposition is from. In the UK, it's from the voters. In the US, it's from the Healthcare Industry.

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 hope though we can push back before then and change things.

https://www.brennancenter.org/our-work/research-reports/citi...

Re: New health insurance “transparency data” looks suspiciously wrong

#126

Post by sbaiddn »

sbaiddn wrote: post #75
christophilus wrote: post #66

Earlier quoted context omitted.

I live with private healthcare. The last few trips to the ER have been 8 hour waits, too. This is an under capacity thing. I live in a place that has boomed, and the mismanaged hospital hasn’t remotely kept up. They fired a bunch of folks during COVID, then shocked pikachu found themselves understaffed. The point is, the entire thing is broken nearly everywhere you look. I don’t know what a better alternative is, but…

I live in the US. Every trip to the ER has had 5). So you millage may vary.

I should add this is for my local ER. Although I've never had a long wait in the US (my wife has), my local ER is literally half empty every time I go there, and the triage area 100% empty.

Re: New health insurance “transparency data” looks suspiciously wrong

#127

Post by [deleted] »

maxwell wrote: post #31
JPws_Prntr_Fngr wrote: post #17

Earlier quoted context omitted.

> seems like it's just insurance companies that can weaponize this data for better rates. That’s because their negotiating power is mainly due to the size of their buying power, not special knowledge or skills. Health “insurance” is basically the lamest, most economically perverted form of collective bargaining ever.

And why federal governments make the best health insurance carriers. Brokers, medical billing staff, and other middlemen serve no purpose other than increasing cost (in order for an inefficient, openly colluding private cabal to invest premiums, deny claims, and collect profit) because everybody needs access to medical treatment.

[deleted]

Re: New health insurance “transparency data” looks suspiciously wrong

#128

Post by paulddraper »

maxwell wrote: post #31
JPws_Prntr_Fngr wrote: post #17

Earlier quoted context omitted.

> seems like it's just insurance companies that can weaponize this data for better rates. That’s because their negotiating power is mainly due to the size of their buying power, not special knowledge or skills. Health “insurance” is basically the lamest, most economically perverted form of collective bargaining ever.

And why federal governments make the best health insurance carriers. Brokers, medical billing staff, and other middlemen serve no purpose other than increasing cost (in order for an inefficient, openly colluding private cabal to invest premiums, deny claims, and collect profit) because everybody needs access to medical treatment.

If you think government doesn't have those things, you don't know much about how it works.

Most of Medicare is administered by middlemen and private companies.

Re: New health insurance “transparency data” looks suspiciously wrong

#129

Post by cmh89 »

softsound wrote: post #120
christophilus wrote: post #66

Earlier quoted context omitted.

I live with private healthcare. The last few trips to the ER have been 8 hour waits, too. This is an under capacity thing. I live in a place that has boomed, and the mismanaged hospital hasn’t remotely kept up. They fired a bunch of folks during COVID, then shocked pikachu found themselves understaffed. The point is, the entire thing is broken nearly everywhere you look. I don’t know what a better alternative is, but…

It's not the same... But what about emergency clinics or walk-in clinics? My brother had a chainsaw accident and they were able to treat him in a few minutes. I kinda hope we get more clinics like this over ER options, I used to go to the ER for a lot of issues until I found these clinics available, now whatever country I'm in America or in Europe I look for them over ER options when available. Good for fevers, fixin…

I don't know where OP is from, but long-waits frequently are because of triaging higher severity rates.

If you have a chainsaw accident and its serious, you arent going to wait 8 hours

Re: New health insurance “transparency data” looks suspiciously wrong

#130

Post by jcrawfordor »

walnutclosefarm wrote: post #83
ethbr0 wrote: post #77

Earlier quoted context omitted.

> 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…

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 variation in how different accounting and analytics systems represent line items. It seems extremely plausible to me that all the numbers in these MRFs are real numbers, but aren't the numbers they're supposed to be. Probably the reports were generated by people using BI tools that didn't have the expertise in the underlying data to understand what values they should actually be reporting on, so it ends up being a hodgepodge of different dollar amounts that are often not the actual reimbursement amount but instead a subtotal or breakdown line items used for analytics.

Sure, insurance companies ultimately know what they paid, but consider that these MRFs are almost certainly not being prepared by the people responsible for that knowledge. They were probably tasked to one or two data analysts who quickly banged them out in whatever BI/reporting tool they use and did nothing to verify correctness. It's not like they had an accountant audit these if they weren't absolutely required to (they weren't). Most healthcare analytics tools are complete junk drawers of data from numerous systems and getting these MRFs right was probably never a priority for anyone. Just a total "I have no idea if these are right but they sure are numbers" exercise.

I mean, how many times have you seen some Tableau report that's all screwed up because some of the MRNs aren't actually MRNs (even though someone named the model field community_mrn) but file numbers from the scheduling system, and now you've got duplicate patients? BI systems just breed that kind of problem unless you are extremely careful about managing them, and since they're "not systems of record" (these are scare quotes) few people are.

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