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Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

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131–140 of 283 posts

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#131

Isn't one of the problems that the price of the total procedures are so different from the component parts / equipment / time, because different providers (and insurers) lump in different categories of cost with different methodologies of billing for overhead items? Or allow different costs to come in? Such that even if you tried to comparison shop across 2 hospitals, you can't really tell whether that is the "all in…

Yes, this is a part of the problem. This is also why it’s hard to interpret the results of studies like this.

Without knowing more about the methodology, it’s possible that a lot of the apparent variation in cost arises from different ways of paying for the same thing. Take a joint replacement surgery—the surgery itself will generate claims for both the surgeon and the hospital, and maybe also the anesthesiologist. Each of those claims could be counted as a bill. But there’s also the initial clinic visit before the surgery as well as the aftercare and rehab, which also generate their own bills. What’s more, some payment models bundle all of those costs into one bill for the entire episode of care. (See how there’s no range listed for the procedures performed at Kaiser?)

The problem arises when you try try to compare those individual claims to the episode of care bills. You can’t, because they’re basically apples and oranges. But if you’re not aware, that can make it seem like there’s more variation than there really is. Don’t get me wrong, though, there is way too much variation in what we pay for health care, but it’s important we measure it precisely.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#132

I'm the technical cofounder of a mid-sized healthcare startup, and when I start explaining hospital administration to people, I start with this - every person working in your hospital or clinic has no incentive whatsoever for you to emerge healthier. The only goal is to maximize the ratio between the amount your insurance is willing to pay, and the amount of care that is provided. In the case of joint replacement, ea…

I worked on the tech-side of healthcare informatics with researchers and healthcare economists. What you say is correct. The cost/benefit ratio of hospital admittance and hospital stays has been quantified to an alarming degree. Not that we shouldn't be looking at such costs, but I feel as though it should involve some level of humanity. The other, often overlooked angle of healthcare in the U.S. is the dynamic at play between for-profit and non-profit hospitals. Both of which require and actively seek profit of course. As others have stated - we need a complete overhaul of the healthcare system here. Something that would require a Teddy Roosevelt-esque stature of a man (or woman) to get started.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#133
post #125

The U.S. healthcare system cannot be fixed. Period. Full-stop. The only solution is to nuke it from orbit, pave it over, and start again. It's very easy to point the finger at the conservative party as the one who's screwed it all up, but the other parties are not really putting forward models for successful healthcare systems. If one were to sit down and try to create the most absurd approach to healthcare that guar…

Senators and congresspeople get their own very high quality insurance. They have no incentive to fix it, their own health care is world-class.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#134
post #133
post #125

The U.S. healthcare system cannot be fixed. Period. Full-stop. The only solution is to nuke it from orbit, pave it over, and start again. It's very easy to point the finger at the conservative party as the one who's screwed it all up, but the other parties are not really putting forward models for successful healthcare systems. If one were to sit down and try to create the most absurd approach to healthcare that guar…

Senators and congresspeople get their own very high quality insurance. They have no incentive to fix it, their own health care is world-class.

That's too easy an answer. They get basically the same options for health insurance as other federal employees. And that insurance is not materially different from the insurance you'd get from any other major employer.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#135

I'm the technical cofounder of a mid-sized healthcare startup, and when I start explaining hospital administration to people, I start with this - every person working in your hospital or clinic has no incentive whatsoever for you to emerge healthier. The only goal is to maximize the ratio between the amount your insurance is willing to pay, and the amount of care that is provided. In the case of joint replacement, ea…

I worked on the tech-side of healthcare informatics with researchers and healthcare economists. What you say is correct. The cost/benefit ratio of hospital admittance and hospital stays has been quantified to an alarming degree. Not that we shouldn't be looking at such costs, but I feel as though it should involve some level of humanity. The other, often overlooked angle of healthcare in the U.S. is the dynamic at pl…

It won't be a great person who saves us.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#136
post #80

Earlier quoted context omitted.

The mess is by design. Goldman Sachs asks in biotech research report: ‘Is curing patients a sustainable business model?’ https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patie... >

Should we be upset that people can't afford to provide cures we don't want to pay for? When I work, I get paid. I expect pharmaceutical companies feel the same way. And if you look at how the world dealt with the hep c cure, it was pretty much trying as hard as possible to pay as little for a cure because the cost was front loaded.

Ah... the problem here is not that the pharma companies aren't getting paid.. The problem is there's a bunch of banks and government subsidies and a lot of middle-people creating cost on top of enabling the funds flow. I am not sure what's the solution, but there really are a lot of administrative middle-people involved..

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#137
post #80
post #11

The US healthcare system is just a completely broken mess. When things go smooth, you are lucky! However, when you have a major procedure, life event or sickness things can get messy quick. We had a child 10 months ago, billing was screwed up by the hospital, then by insurance and we are still in process of getting it resolved. I have now spent at least 8 hours on the phone. I had a surgery, called insurance and veri…

The mess is by design. Goldman Sachs asks in biotech research report: ‘Is curing patients a sustainable business model?’ https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patie... >

Someone said something somewhere is not actually evidence of anything. Also, the answer is "yes", because new patients are always being born.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#138
I had to check myself out against doctor's wishes after a serious heart incident. They kept sending doctor after doctor in to "consult"—each one adding a huge fee to the final bill. The hospital's "billing assistant" was NEVER available, after days.

I became informed on additional tests they considered doing, and eventually arranged for related tests outside the hospital to determine if the tests they were going to do were necessary. They were not.

Bill was just under $60,000, ~$8,000 deductible, paid the deducible in one lump sum and negotiated a 25% discount. A partner at a medical firm told me they are only paid 75%, so it made sense to him that I could negotiate a 25% discount.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#139
Another example of how bananas the system is: when I go to order prescription refills through my health care provider, it is currently unable to tell me how much it's going to cost me. You're expected to say "Ok, charge me whatever these cost" and then, I suppose, call customer support if you don't agree with the price you were charged that day.

I don't know if there's some kind of a "price of the day" marketplace calculation that needs to happen for the provider to find out the current prices, but that's pretty odd. It's like buying stocks or a Dungeness crab dish at a restaurant.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#140

Earlier quoted context omitted.

The providers should get paid every month that you’re in excellent health. Imagine how many cheap cures we would “suddenly discover”.

That would lead to a model where healthcare spending is directed to attracting healthy patients and refusing unhealthy patients.

In other words, the pre-ACA individual insurance market.
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