Hospitals pledge to fight admin price transparency plan in court • Hacker News Board

Re: Hospitals pledge to fight admin price transparency plan in court

#151

Post by legitster » Tue, Nov 19, 2019, 6:57 PM UTC

bluGill wrote: post #114

legitster wrote: post #8

The previous administration had a similar effort that failed. I hope that this effort is successful. >"For instance, it could allow one provider to follow and match the prices of the other provider (like two gas stations across the street from one another who face no other competition)," Garmon said. I understand this argument, but I think they underrate how much people are willing to shop around when they actually h…

I'd pay more for quality. If I knew hospital X is better at hip replacement I'd pay extra to go there. Of course how much extra I'm not sure, and I'm also not sure how you compare hip replacement quality like that. It is only emergency rooms where I don't get a choice - if you need an emergency room close is important.

Unfortunately, under the current system, price and quality of care are relatively uncorrelated. Which makes sense as we learn how arbitrary pricing is.

But as I understand how medical billing actually works, if only a single patient uses an MRI machine in a year, they would pass on the entirety of the cost to the single patient. But a hospital that uses the MRI constantly spreads the cost across all patients. In the latter hospital, they would also have better outcomes since they have more experience and specialization in the procedure.

This is also the opposite of how it would work in a market-based industry. In an auto-shop, I know how much I can charge for any service, and before buying equipment and personnel to expand my services, I determine if it is worthwhile to invest the capital.

Re: Hospitals pledge to fight admin price transparency plan in court

#152

Post by coredog64 » Tue, Nov 19, 2019, 6:57 PM UTC

braythwayt wrote: post #62

coredog64 wrote: post #30

Earlier quoted context omitted.

So in your opinion, neither France nor Switzerland are “functioning, civilized countries”? Price discovery works for a certain kind of care (e.g. non-emergency outpatient care), and we shouldn’t discard it without any consideration.

I am not familiar with France, but the first line in Wikipedia is: "The French health care system is one of universal health care largely financed by government national health insurance." https://en.wikipedia.org/wiki/Health_care_in_France Then when I look into Switzerland, I see: "Healthcare in Switzerland is universal and is regulated by the Swiss Federal Law on Health Insurance. There are no free state-provided h…

I guess that’s the difference between Wikipedia and using it :)

How the French government finances insurance is orthogonal to how consumers purchase outpatient care.

The capsule summary is that patients go to the doctor. The pay 100% of the visit cost. The insurance company reimbursement is 80% of “reasonable and customary “ value that is widely known. Et voila, functioning price discovery without a dystopian society.

(There are some caveats. If you’re indigent, the government gives you a special card that allows the provider to bill the insurance directly. You can buy private insurance that covers your 20% and doesn’t require as much reimbursement hassle at the cost of constraining your provider choice. And naturally none of this applies to inpatient hospital admissions)

Re: Hospitals pledge to fight admin price transparency plan in court

#153

Post by carapace » Tue, Nov 19, 2019, 6:58 PM UTC

(EXPLETIVE DELETED! I try to avoid low-content comments, i do, but goddmnit it pisses me off to hear them say, "Oh the poor patients will be so confused!")

Re: Hospitals pledge to fight admin price transparency plan in court

#154

Post by whb07 » Tue, Nov 19, 2019, 6:59 PM UTC

jakobegger wrote: post #133

triceratops wrote: post #39

Earlier quoted context omitted.

Americans already have co-pays, deductibles, coinsurance and whatever other terms the insurance industry has cooked up, with no visible effects on costs. In addition to your other changes the following would also help: - Allow competition. Don't give hospitals the power to veto new hospitals in their area. - Disallow regional consolidation of hospital systems and medical practices. Regional monopolies are bad. - Incr…

Or, you could do what other developed countries do: Don't rely on private for profit hospitals. Here, most hospitals are run either by cities or counties, or by the public insurance companies themselves. This ensures that hospitals have an incentive to be efficient. There are private hospitals, but only very few people go there, since they are very expensive, and you get good care in the public hospitals.

So a quick way to check reality is by looking at behavior, so say you wanted the "best" care for something no matter the costs. Most people would fly to the U.S from wherever. That is telling you something.

I agree the "general" care like broken bones etc its probably all the same, but healthcare innovation is done in the U.S. So it is kind of moot to say "its good here"... yes after the innovation trickles its way over to your country.

Lastly, one of my best friends is studying to become a doctor, in fact is a resident now. He is getting paid the princely salary of $55k after 15 years of studying and he has many years to go before he's able to really realize any gains.

To make the profession a civil servant's position is insanity.

Re: Hospitals pledge to fight admin price transparency plan in court

#155

Post by notyourday » Tue, Nov 19, 2019, 6:59 PM UTC

mywittyname wrote: post #90

Thriptic wrote: post #71

Earlier quoted context omitted.

Lab tests are particularly complicated to price because usually they are being processed by someone else. Usually labs won't even try to get an authorization from insurance until they get your sample and start working on it as it affects their turnaround time which is one of their main differentiators, and each insurer will have different rules about what they will pay for under what conditions (insurers also have se…

> The short answer is they can't tell you because they don't know. Bingo. My partner works in revenue cycle management (arguing with insurance companies to pay their bills) for a large hospital chain, and even she can't get accurate prices for procedures. She can walk down the hall to the finance department, and ask them, but even they can't figure it out. I found this out after asking her why they don't prioritize c…

> Bingo. My partner works in revenue cycle management (arguing with insurance companies to pay their bills) for a large hospital chain, and even she can't get accurate prices for procedures. She can walk down the hall to the finance department, and ask them, but even they can't figure it out.

That's because they are not properly incentivized. It is very simple to solve this problem: charge them with fraud. Same way as a doctor who overbills Medicare would be charged with fraud.

We had this kind of things before Enron - CEOs pretended that they cannot possibly know if the numbers in the accounting documents were correct because it was oh so complicated. Now, however begrudgingly, they do sign off on the books and since they are personally responsible they have all the needed incentives.

Re: Hospitals pledge to fight admin price transparency plan in court

#156

Post by nix0n » Tue, Nov 19, 2019, 6:59 PM UTC

ddlatham wrote: post #95

istjohn wrote: post #22

I spent 45 minutes at the hospital where I was to get a lab test done, trying to get a quote for said test. Prescribing doctor didn't know the cost. Lab tech didn't know. Billing department told me I needed a procedure code. Lab tech who was ready to draw blood couldn't tell me the needed code even after spending five minutes at a computer looking for it. Prescribing doctor gave me the code. Called back billing. They…

How does contract law fit in here? If a business performs a service for me and won't tell me ahead of time how much it costs, can it afterward decide I must pay whatever it wants? One trillion dollars? For those without insurance, is there some contract agreed to with the hospital? For those with insurance, in which contract do I end up bound to pay an amount that isn't told me until after I've already made the decis…

One of the things you sign when you visit a doctor or hospital says that you'll pay whatever insurance doesn't cover.

I've seen maybe 10 versions of this and none list any limits.

If you were charged $1T you might be able to challenge it in court.

If you simply don't pay, the bill collectors will start harassing you, and your credit score will suffer.

I'm not sure at what stage they are allowed to take your wages etc.

Medical bills are a leading reason for bankruptcy in the USA.

Re: Hospitals pledge to fight admin price transparency plan in court

#157

Post by maerF0x0 » Tue, Nov 19, 2019, 7:02 PM UTC

bluGill wrote: post #132

maerF0x0 wrote: post #49

> Transparency is not going to work where there is no competition, Emily Gee, a health economist at the left-leaning Center for American Progress, told Healthcare Dive. That's bs. I will drive to a further away hospital if it saves me $75 an hour of time spent... (edit: clearly I'm talking about non-emergency here)

But it won't. Your insurance will pay for it either way, so you are spending an hour of your time to save your insurance $75 - which won't even be given back to you in form of lower premium.

> Your insurance will pay for it either way

This is an assumption based on a very good insurance package. Most have out of pocket co-pays . So yes, we have to gross it up by the co-pay percent and discount it by the Annual deductible limitt, but generally the point stands. If I can save enough money I might travel away from the monopoly. Until that data is transparently available I can't optimize that scenario w/ my own choices.

> which won't even be given back to you in form of lower premium

Systemically it will eventually if insurance companies are competing with eachother for your business

Re: Hospitals pledge to fight admin price transparency plan in court

#158

Post by umvi » Tue, Nov 19, 2019, 7:02 PM UTC

commandlinefan wrote: post #147

umvi wrote: post #120

Earlier quoted context omitted.

Yeah but come on. It's one thing to program something with nebulous requirements. The cost of the X-ray machine is known. The cost of collecting X-rays can be calculated deterministically. The only thing similar to programming is trying to diagnose a rare disease or tricky condition. But for run-of-the-mill deterministic procedures, the cost should absolutely be known.

Well, I think so too, but - just to play devil’s advocate - many of my former bosses would almost certainly say something like, “the cost of the web server is known. The cost of collecting the web traffic can be calculated deterministically. We’re just talking about a website here, the cost should absolutely be known.”

Well are you asking me to setup infrastructure or to design you a website? The first is deterministic and I can certainly give you a fixed price/timeframe to set up your web servers/DNS/etc.

Designing a website on the other hand, isn't deterministic. That mandates lots of requirements gathering and suffering through iterations where the peanut gallery criticizes every CSS choice and demands minor CSS tweaks until some arbitrary "feel" is achieved.

Re: Hospitals pledge to fight admin price transparency plan in court

#159

Post by wswope » Tue, Nov 19, 2019, 7:04 PM UTC

soneca wrote: post #143

The Econtalk podcast latest episode is about a surgery clinic in Oklahoma that has full price-transparency policy. I am outsider to US healthcare system, but after listening to it, it seems hardly controversial what would be the right thing to do here: https://www.econtalk.org/keith-smith-on-free-market-health-c...

Texas Free Market Surgery offers a near identical business model based out of Austin.

Green Imaging (who I used to work for) offers cash-pay imaging services for all modalities across Texas, and are in the process of expanding nationally. Because they contract with existing imaging facilities, they don't post prices publicly to avoid poaching patients, but if you call in or message them through the website, they'll give you an up-front price for any service they offer.

For family practice/general medicine, there's a business model called "Direct Primary Care" that offers you unlimited primary care services, usually for a cost of $50-80/month, and most big cities will have a few providers following this model.

A lot of progress is being made in terms of transparent/affordable outpatient and day surgery services, but it's hard to get spread the word because the current healthcare model is so entrenched.

Re: Hospitals pledge to fight admin price transparency plan in court

#160

Post by woopwoop » Tue, Nov 19, 2019, 7:05 PM UTC

aphextim wrote: post #142

TurkishPoptart wrote: post #118

Earlier quoted context omitted.

What was it? Thanks.

Original title that they changed which my original comment was based off of was, 'Hospitals pledge to fight Trump admin price transparency plan in court' Removing the word Trump (trigger word) is what dang was referring to.

Oh. I still don't understand how the word "Trump" makes the title non-neutral.