Hospital creates bidding war by posting pricing online • Hacker News Board

Re: Hospital creates bidding war by posting pricing online

#201

Post by 11Blade » Wed, Jul 10, 2013, 12:48 PM UTC

This article is a bit misleading. An outpatient surgery center has the luxury of "skimming" the easy uncomplicated same-day surgeries while leaving the hospitals to do the heavy lifting. It is not a hospital

Surgery centers do not have the cost of carry of a pharmacy(24/7), a fully functioning diagnostic lab(24/7), an emergency room(24/7), 200-1000 beds, ICU,CCU, radiology department(24/7) etc and an infrastructure that is impressively expensive.

Its very very very easy to offer these surgeries at a cheaper price than a hospital but when you need a complicated surgery or an emergency that surgery center will not be there for you.

I like the idea of pricing transparency but it should be hand in hand with outcome and quality statistics and comparisons should be fair.

I did not see Oklahoma surgery center compare themselves to other surgery centers which are likely very close in price.

One last thing. In healthcare - price is not everything (its an important issue) but as we drive down the price, we must not sacrifice but rather improve outcome measurement and quality.

Re: Hospital creates bidding war by posting pricing online

#202

Post by maxerickson » Wed, Jul 10, 2013, 12:49 PM UTC

draz wrote: post #199

maxerickson wrote: post #134

Earlier quoted context omitted.

Do they actually negotiate deals with insurance companies where they lose money on some procedures? If they don't, then the problem is that they want the revenue from the higher paying insurance, not worries over fraud.

Yes, they want more money from higher paying insurance. But if they were to officially have a menu of prices for different entities (self pay, insurance A, insurance B, etc), that'd be against the law. So they come up a "catch all" number, and they grab as much as they can get from each entity.

My point was that there is some matter of perspective in there. They could just as well offer a single price that reasonably covered their costs, but instead they are engaging in revenue maximization. So the menu is a rational tradeoff of revenue maximization and fraud avoidance, but it isn't the only one.

"Insurance companies won't play the game that way" is sort of an answer, but it isn't very satisfying.

I guess fraud statutes might benefit from some rules about the ratio between average negotiated prices and stated prices (I'm a little uncomfortable telling entities how they are allowed to price things, but large medical institutions clearly have some dysfunction in this area).

Re: Hospital creates bidding war by posting pricing online

#203

Post by chiph » Wed, Jul 10, 2013, 1:09 PM UTC

lawnchair_larry wrote: post #165

MattBearman wrote: post #29

Earlier quoted context omitted.

Wow, this (along with the whole health care thing) makes me glad I live in the UK. Here renting property is very well regulated, you put down a security deposit when you move in (usually 1.5 months rent) and then any charges like this are taken from that. The best part is the security deposit legally has to be left with a third party (DPS), and then if the land lord wants to keep any of it, they have to go through th…

It's a relatively new trend in the US for corporate owned rental properties to use essentially fraudulent nickel-and-diming on the damage deposit as an additional revenue stream. If you move to the US and have to rent, find a private owner renting their condo or similar. Never live in an "apartment community" with a corporate owner.

I am paying $15 a month "pet rent" for my cat. I am under no illusions that when I move out they will use my cat as an excuse to keep the deposit.

Re: Hospital creates bidding war by posting pricing online

#204

Post by GFischer » Wed, Jul 10, 2013, 1:51 PM UTC

refurb wrote: post #147

badclient wrote: post #121

Earlier quoted context omitted.

It is a combination. First, healthcare debt isn't weighted as heavily on credit reports. Second, healthcare is one of the few businesses where it is illegal to deny services before payment. You can't walk into a walmart, grab a candy bar and just walk out. With emergency healthcare, you can do just that and sadly, too many people take advantage of it.

To give you an idea of how big of a problem not paying is, I'll relate a story I heard from a small business owner in California: In an effort to provide his blue collar workers with a decent benefits package, he setup a health insurance plan. After 6 months or so, his HR person came back and said "none of the employees have used the insurance at all!" This was weird since these workers had families and obviously chi…

How is that NOT screwed up?

I'm amazed at the ways the U.S. healthcare system is so much worse than most of the rest of the world's.

I guess there are humungous lobbying efforts and entrenched interests to make it stay the way it is.

The caveat being, it also has some of the most advanced medical technology and procedures too, but the day-to-day healthcare is surely the worst.

How it works here in Uruguay:

There are three levels of care

1) Universal (public) healthcare, you just show at the door and you're admitted. The quality is poor (although doctors are mostly good), and some hospital conditions are close to appalling, but it's 100% free (paid by taxpayers blablah), even up to cancer or AIDS treatment (yes, thousands of dollars). Time to treatment is also very bad for surgeries and other conditions.

2) Almost-universal healthcare in a co-op mode (Mutualism, "Mutualistas" and FONASA). Anybody who works or draws a pension has the right to one of those for himself and his children. Quality is decent, and there are some small costs associated (U$ 5 per doctor visit, and a few hundred dollars for major events). Medicine is provided by the hospital at an extreme discount (usually U$ 5 for any medicine, including the ones costing hundreds of dollars. Generics are mandatory whenever possible). The thing is, it's becoming a bit overcrowded and quality is going down, government is over-regulating IMO.

3) Private insurance, US-style. This one can replace 2) although 1) is still free to everybody (double coverage). That one gives access to the very best hospitals, doctors, etc... but it's the most expensive by far, and usually doesn't cover medicines outside of hospital stay.

Re: Hospital creates bidding war by posting pricing online

#205

Post by Splendor » Wed, Jul 10, 2013, 1:52 PM UTC

lettergram wrote: post #79

showerst wrote: post #27

Earlier quoted context omitted.

Copying my comment below. The government not only allows healthcare providers to reveal their prices, it encourages it. The graf about the government is a political statement, not a policy fact, and does not belong in a news story. ----- Medicare/caid prices are standardized and public. They also release data on what specific hospitals bill for the most common procedures. http://www.cms.gov/Research-Statistics-Data-a…

I worked in a billing office for 5 years, there are literally thousands of codes for EACH insurance company, again EACH insurance company. The reason the cost of healthcare is so high is because medicare pays roughly 15% of a bill, others are somewhere between 20-50% of a bill depending. That is to say if the doctor charges you $40,000 you pay your 10% co-pay of $4,000 and the insurance then only pays maybe another $…

This is incorrect. Procedure codes are standardized across the industry (CPT codes, HCFA codes, etc.). Don't confuse figuring out the correct code to bill for a procedure with determining some proprietary code for each insurance company; that is simply false.

Re: Hospital creates bidding war by posting pricing online

#206

Post by yaix » Wed, Jul 10, 2013, 2:16 PM UTC

> The move is revolutionizing medical billing in Oklahoma and around the world.

Around the world? Not really.

Re: Hospital creates bidding war by posting pricing online

#207

Post by fizzbar » Wed, Jul 10, 2013, 2:30 PM UTC

lettergram wrote: post #79

showerst wrote: post #27

Earlier quoted context omitted.

Copying my comment below. The government not only allows healthcare providers to reveal their prices, it encourages it. The graf about the government is a political statement, not a policy fact, and does not belong in a news story. ----- Medicare/caid prices are standardized and public. They also release data on what specific hospitals bill for the most common procedures. http://www.cms.gov/Research-Statistics-Data-a…

I worked in a billing office for 5 years, there are literally thousands of codes for EACH insurance company, again EACH insurance company. The reason the cost of healthcare is so high is because medicare pays roughly 15% of a bill, others are somewhere between 20-50% of a bill depending. That is to say if the doctor charges you $40,000 you pay your 10% co-pay of $4,000 and the insurance then only pays maybe another $…

Re: negotiating your bill: It blows my mind that in America you would approach paying for healthcare the same way you would purchase an expensive car. I don't consider my health to be a luxury good... But in the USA it is priced as such?!

Re: Hospital creates bidding war by posting pricing online

#208

Post by arethuza » Wed, Jul 10, 2013, 2:38 PM UTC

bradleyjg wrote: post #191

mbreese wrote: post #186

Earlier quoted context omitted.

Medical schools are free to set their own limits on the number of students they admit. But they aren't going to admit more students than they predict can find a residency spot. It would look bad to have a high percentage of your students not be able to find a residency. The real reason why there are fewer doctors is that it simply doesn't make any economic sense to be a doctor anymore. You need too much school, at to…

Sheer and utter nonsense. First there are a huge number of students who wish to go to medical school and don't get in. There's no shortage of applicants at all. Second the incredibly high compensation for speciality doctors quickly overcomes both opportunity cost and tuition costs as compared to almost any other profession. I encourage you to run the numbers. You will find that $250k/year catches up very quickly to $…

Out of interest, is there any good reason why medical degrees have to be done as second degrees in the US? Doesn't that add hugely to the cost of becoming a doctor?

Re: Hospital creates bidding war by posting pricing online

#209

Post by mbreese » Wed, Jul 10, 2013, 3:04 PM UTC

bradleyjg wrote: post #191

mbreese wrote: post #186

Earlier quoted context omitted.

Medical schools are free to set their own limits on the number of students they admit. But they aren't going to admit more students than they predict can find a residency spot. It would look bad to have a high percentage of your students not be able to find a residency. The real reason why there are fewer doctors is that it simply doesn't make any economic sense to be a doctor anymore. You need too much school, at to…

Sheer and utter nonsense. First there are a huge number of students who wish to go to medical school and don't get in. There's no shortage of applicants at all. Second the incredibly high compensation for speciality doctors quickly overcomes both opportunity cost and tuition costs as compared to almost any other profession. I encourage you to run the numbers. You will find that $250k/year catches up very quickly to $…

I encourage you to talk to some doctors. No one makes $250k per year, except maybe a few surgery specialists (and maybe ER). Primary care doctors (the ones that where there actually is a shortage) can can easily start at under $100k and the max can be below $200k. And if you are a pediatrician or a pediatric specialist, expect to take a cut in pay relative to your adult colleagues.

Re: Hospital creates bidding war by posting pricing online

#210

Post by ceejayoz » Wed, Jul 10, 2013, 3:06 PM UTC

bengebre wrote: post #30

As someone with an High Deductible Healthcare Plan, I pay most medical costs out of pocket up to an annual limit. It's crazy that for such expensive services I NEVER know what my bill is going to be until months after the procedure has happened. I always try to guesstimate costs beforehand, but I've been off by an order of magnitude on more than one occasion. Having transparent pricing in the healthcare world, even i…

> It's crazy that for such expensive services I NEVER know what my bill is going to be until months after the procedure has happened.

Not only that, but one often doesn't know if insurance will cover it, at all. One of my wife's surgeries was "pre-authorized" but rejected by insurance when the bill came through.