I analyzed hospital price lists so you didn't have to • Hacker News Board

Re: I analyzed hospital price lists so you didn't have to

#191

Post by cycomanic » Thu, Jul 07, 2022, 5:39 AM UTC

celdon25 wrote: post #67

Here's a solution: Let doctors be doctors and not glorified algorithmic-assembly-line workers. Incentivize transparency through something better than Yelp reviews. Incentivize diagnostic outpatient facilities, make them more accessible and discoverable. Especially through telemedicine if possible, but make sure they can be seen in person by someone competent if needed. I'm sure I'll get downvoted here for this part,…

> And for Christ's sake, stop training doctors to ask "what are your symptoms" (when they are already reasonably aware of what the type of issue is), and use more yes/no questioning about specific symptoms. If doctors can't be trained fast enough to be able to do even that, I'd think about fixing that, too.

I think you really don't understand enough about why these things get asked. Yes Gp work often seems like glorified flowcharts at first glance (especially if you only look at some of their study material), but once you dig into it (I helped my partner study for an exams and get to hear her stories every day), you realise the huge amount of background information that can flow into a diagnosis. Asking the patient about their symptoms is an important part of gathering the history and can not be done just with yes or no questions.

Re: I analyzed hospital price lists so you didn't have to

#192

Post by zxexz » Thu, Jul 07, 2022, 5:40 AM UTC

throw123123123 wrote: post #179

social_quotient wrote: post #21

Why can’t insurance companies post the actual price they are paying and being charged by the hospital with proper billing taxonomies. They seem like they probably have these things well ironed out since they actually deal with various hospitals whereas hospitals only deal with themselves.

Because they don't know it yet. They audit and review each claim a an office sends, which starts a negotiation process to see if each claimed item by the physician was warranted and done properly. All that information is codified then into a level of visit, which changes the amount it will be payed out. It is grotesquely complex, but the core issue here is that patients want to consume their healthcare through insura…

Congress has been considering transparent, prior authorization legislation in the realm of CMS. I don't know much about it, but they did publish an RFI recently[0]. I hear it has bipartisan support (that's obviously hearsay, but a lot of this recent healthcare legislation that has been passed has not been divided along party lines, AFAICT)

[0] https://www.federalregister.gov/documents/2022/01/24/2022-01...

Re: I analyzed hospital price lists so you didn't have to

#193

Post by GoOnThenDoTell » Thu, Jul 07, 2022, 5:44 AM UTC

throw123123123 wrote: post #173

diob wrote: post #165

Earlier quoted context omitted.

The irony of attributing the free market healthcare disaster we have here to regulation. Things are plenty regulated in Australia and other socialized countries and they have none of the crazy billing / coverage issues we have. It's frankly, bullshit.

It's not the same regulation.

Effective regulation is somewhat of an organisational skill.

Perhaps its just low pay attracting low talent

Re: I analyzed hospital price lists so you didn't have to

#194

Post by ineptech » Thu, Jul 07, 2022, 5:45 AM UTC

duffpkg wrote: post #65

Wrote Hacking Healthcare for O'Reilly, created ClearHealth/HealthCloud open source EMR, managed health systems for 15+ years, blah, blah, blah. It is very good there is are the transparency regulations. It is worth briefly explaining some of the reasons why many facitilities are having a hard time complying. There are some bad actors, absolutely true. However "Hanlons Razor" -- never attribute to malice that which is…

> Everyone is deathly afraid of making too many changes too fast because when those systems break the money stops flowing and a health system will literally go insolvent.

Isn't this the desired outcome, that such organizations go broke? And let their assets, employees and customers go to some other organization that isn't saddled with technical debt?

Re: I analyzed hospital price lists so you didn't have to

#195

Post by mushbino » Thu, Jul 07, 2022, 5:45 AM UTC

zrail wrote: post #94

mushbino wrote: post #83

Earlier quoted context omitted.

Not just if you have money. If you have a lot of money. The majority of the country is one major accident away from being completely wiped out. It's the number one cause of bankruptcy. I had an emergency this year within a very tiny insurance gap between employers and now all of my savings and retirement are gone. I'm really not sure who it works out better for versus universal healthcare, but I can't imagine it's a…

Was retroactively electing cobra not an option for some reason?

Longer story, but the timing of the emergency and recovery period fell within an ineligibility window for COBRA. My previous insurance company wouldn't have covered it anyway. It was the worst Blue Shield plan that I didn't even know could be legal. Also, I got the first few bills, was like okay, I'll just pay these off and move on and not even bother. These were the only bills I could find in their patient portal at the time. Then I got hit with the massive ones that made my head spin. By that time I had started at my new employer, my new insurance hadn't kicked in and I was outside of the COBRA window, not that it would have covered it anyway.

From now on I'm making sure I have good insurance, which requires a crazy amount of due diligence, but not something I'll take for granted anymore. It's one of reasons I'm currently trying to move to another country. Quality of healthcare is important, but how much does it matter if you're in massive debt, lost nearly everything, and don't have a retirement anymore?

Re: I analyzed hospital price lists so you didn't have to

#196

Post by gricardo99 » Thu, Jul 07, 2022, 5:47 AM UTC

smolder wrote: post #160

duffpkg wrote: post #65

Wrote Hacking Healthcare for O'Reilly, created ClearHealth/HealthCloud open source EMR, managed health systems for 15+ years, blah, blah, blah. It is very good there is are the transparency regulations. It is worth briefly explaining some of the reasons why many facitilities are having a hard time complying. There are some bad actors, absolutely true. However "Hanlons Razor" -- never attribute to malice that which is…

The difficulty of fixing and improving these systems is frankly overrated. It has more to do with penny pinching and profiteering that they haven't modernized. I don't mean a rewrite in JavaScript either, I mean sensible engineering, which many people are ready to do but not paid to do, because it weakens the upwards money vacuum the finance cabal wants to maintain. Progress isn't profitable enough according to the E…

Exactly. IT, software, systems, etc… are viewed as a cost center. Hospitals aren’t in the business of selling software. How do you increase profits (or get yourself promoted, a bigger bonus)? One way is contain or reduce cost centers. The incentives are stacked against overhauling antiquated systems and modernizing, at least until the issue is forced by major business disruptions or regulations.

Re: I analyzed hospital price lists so you didn't have to

#197

Post by ac29 » Thu, Jul 07, 2022, 5:47 AM UTC

micromacrofoot wrote: post #77

spaetzleesser wrote: post #63

Earlier quoted context omitted.

"No, the solution to most social ills in America is to simply not be poor. If you are poor, stop " In healthcare not being poor is sufficient. You actually have to be quite well off in order to not worry about cost.

Yes! My salary is twice the local average and still worry a medical event could wipeout my life savings.

There are annual out of pocket maximums. Mine is something like $7000 last I checked. Its a lot of money, but not an amount that would bankrupt most people.

Re: I analyzed hospital price lists so you didn't have to

#198

Post by obventio56 » Thu, Jul 07, 2022, 5:55 AM UTC

diob wrote: post #165

smolder wrote: post #160

Earlier quoted context omitted.

The difficulty of fixing and improving these systems is frankly overrated. It has more to do with penny pinching and profiteering that they haven't modernized. I don't mean a rewrite in JavaScript either, I mean sensible engineering, which many people are ready to do but not paid to do, because it weakens the upwards money vacuum the finance cabal wants to maintain. Progress isn't profitable enough according to the E…

The irony of attributing the free market healthcare disaster we have here to regulation. Things are plenty regulated in Australia and other socialized countries and they have none of the crazy billing / coverage issues we have. It's frankly, bullshit.

It seems more regulated healthcare systems are also significantly less capable of developing innovative treatments (although this could be a misunderstanding of mine)

Re: I analyzed hospital price lists so you didn't have to

#199

Post by kelnos » Thu, Jul 07, 2022, 5:55 AM UTC

smolder wrote: post #160

duffpkg wrote: post #65

Wrote Hacking Healthcare for O'Reilly, created ClearHealth/HealthCloud open source EMR, managed health systems for 15+ years, blah, blah, blah. It is very good there is are the transparency regulations. It is worth briefly explaining some of the reasons why many facitilities are having a hard time complying. There are some bad actors, absolutely true. However "Hanlons Razor" -- never attribute to malice that which is…

The difficulty of fixing and improving these systems is frankly overrated. It has more to do with penny pinching and profiteering that they haven't modernized. I don't mean a rewrite in JavaScript either, I mean sensible engineering, which many people are ready to do but not paid to do, because it weakens the upwards money vacuum the finance cabal wants to maintain. Progress isn't profitable enough according to the E…

Right, and the fact that they are in this mess of tech debt in the first place is because they've cut corners and pinched pennies over many many decades. We shouldn't just nod our heads and be all like, "ah yeah, that's annoying, no way it could be helped". I'm so tired of companies continuing to be short-sighted about technical debt. Clearly it's been that way for more than 50 years, and we continue to validate this sort of behavior with understanding and extending deadlines.

Fine these people out of existence and let someone competent (if such a person exists) pick up the pieces and start anew.

Re: I analyzed hospital price lists so you didn't have to

#200

Post by solresol » Thu, Jul 07, 2022, 6:01 AM UTC

obventio56 wrote: post #198

diob wrote: post #165

Earlier quoted context omitted.

The irony of attributing the free market healthcare disaster we have here to regulation. Things are plenty regulated in Australia and other socialized countries and they have none of the crazy billing / coverage issues we have. It's frankly, bullshit.

It seems more regulated healthcare systems are also significantly less capable of developing innovative treatments (although this could be a misunderstanding of mine)

I think it is a misunderstanding. The two places in the world where everyone agrees it is easiest to get medtech devices developed are Australia and Mexico.

(Source: was doing medtech development for a while in the early 2010s).