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

Re: Hospital creates bidding war by posting pricing online

#221

Post by bobwyman » Wed, Jul 10, 2013, 7:31 PM UTC

At hospitals in the US, every payer is charged a different price. Large insurers and HMO's negotiate large discounts which shifts costs onto smaller insurers who get smaller discounts and thus pay part of the costs of their larger competitors. The non-poor uninsured, who often can least afford to pay, are charged the most -- often 5X, 10X or more than what Medicare or a large insurer would pay. In all states other than Maryland, which has state-wide "all-payer" pricing, what you are charged depends more on who you are and how much negotiating power you have than what was done for you.

The solution is to let the "free market" work. Of course, that means we need to regulate the market to fix the existing "market failure." Free markets are regulated markets. (Although not all regulated markets are free.)

All states should pass laws saying that hospitals are free to charge what they want but that their prices must be posted and apply to "all-payers" without discounting. Additionally, states should develop all-payer databases like those advocated by: http://www.apcdcouncil.org/

Much has been said about Medicare in the comments here that isn't quite accurate. The reality is that Medicare ignores hospital charges (except in Maryland) and pays according to their own calculations of hospitals' costs. In most cases, that means they pay much less than they are charged. However, in some cases, it means that they pay more.

For some additional background on this issue, from a New York perspective, see my PDF on the subject linked to at: http://bobwyman.blogspot.com/2013/04/RFC-FRAND.html

Re: Hospital creates bidding war by posting pricing online

#222

Post by bobwyman » Wed, Jul 10, 2013, 8:15 PM UTC

ChuckMcM wrote: post #22

I really salute these guys for doing this. It's freakin' awesome. This I've added to my next letter to my representatives in Congress: "Dr. Smith said federal Medicare regulation would not allow for their online price menu. They have avoided government regulation and control in that area by choosing not to accept Medicaid or Medicare payments." I've suggested that one non-controversial way in which Healthcare could b…

It is not correct to say that Medicare "would not allow" online pricing. Medicare doesn't care what hospitals charge. Medicare ignores hospital charges. It only pays what Medicare calculates is a fair price based on what hospitals report as their actual costs. It would be more reasonable to say that Medicare will ignore any posted prices whether or not they are posted online.

Re: Hospital creates bidding war by posting pricing online

#223

Post by lostlogin » Wed, Jul 10, 2013, 11:10 PM UTC

sseveran wrote: post #215

horacio wrote: post #162

Earlier quoted context omitted.

I believe the article you're referring to is Steven Brill's 26,000 word opus "Bitter Pill - Why Medical Bills Are Killing Us", which appeared in the U.S. edition of Time Magazine in March of this year. In it, he makes a specific criticism that not only do hospitals that purchase diagnostic scanners tend to make greater use of it, but that quite often, an above-average count of referrals to diagnostic imaging centers…

Not only that but my observation after working for 10 years in radiology is that many other departments either outsource diagnosis to radiology or at least want a study done. That way in case there is a lawsuit the finger can be pointed somewhere else. While this effect is hard to quantify it is definitely encouraged by hospital executives since radiology can be a highly profitable department.

I work in radiology too - interesting that we have come to the same conclusions for different reasons. You can't sue here (at least not easily) as there is a system of compensation for blunders etc and yet supply really doesn't follow demand and pricing is arbitrary.

Re: Hospital creates bidding war by posting pricing online

#224

Post by hysterix » Thu, Jul 11, 2013, 1:50 AM UTC

HarryHirsch wrote: post #3

This happens only now ? In more civilized countries like Germany, prices for procedures have been set since time immorial. There is a provision for surcharges from the physician, but these aren't common, and the physician will have to have a good cause or the insurer will not pay it. Same thing for new medications: they are not permitted in the clinic unless there is a genuine advantage for the patient. All this is o…

Really? You are really going to imply America is uncivilized when you compare it to a country that literally attempted to take over the world and exterminate an entire race of people? Within recent generational memory no less?

Europeans come in two flavors, smug, and really really smug. When will you all get off your high horses?

I think I should say it again because it bears repeating. The country that you just compared america to, implying we are not civilized and germany is, literally attempted to take over the world and exterminate an entire race of people. Civilized? Really?

At least our country was on the right side.

Re: Hospital creates bidding war by posting pricing online

#225

Post by milesskorpen » Thu, Jul 11, 2013, 6:43 AM UTC

justincpollard wrote: post #184

refurb wrote: post #168

Earlier quoted context omitted.

Exactly, these employees would take their children to the emergency room/urgent care. They weren't getting check-ups, but if the kid had a high fever, they would bring them in, get them seen by a doctor, then be on their way. When asked about billing they simply said "I don't have insurance". Many hospitals, including the DSH (disproportionate share hospitals) write these things off all the time. The hospital just do…

I know you're just providing a hypothetical example, but I think it's common for services provided by doctors or a hospital emergency room to cost quite a bit more than $100; in many cases an order of magnitude more. At the end of the day, I do agree that a hospital will or should make a collection decision based on a cost benefit analysis of some kind, but I think that decision will be to collect a good portion of t…

While the bill might be $1k+, the amount collections would reasonably collect is probably more in the $100 range for what amount to doctors visits.

Re: Hospital creates bidding war by posting pricing online

#226

Post by ultim8k » Thu, Jul 11, 2013, 8:27 AM UTC

Hospitals and medication MUST be free for everyone! fsck companies and money. Health doesn't have a price!

Re: Hospital creates bidding war by posting pricing online

#227

Post by gscott » Thu, Jul 11, 2013, 9:01 AM UTC

refurb wrote: post #168

lawnchair_larry wrote: post #163

Earlier quoted context omitted.

This isn't true. They only have to provide emergency services, and they still charge for them, just not up front. If anyone did that, they would still receive bills in the mail and have derogatory information on their credit report. Otherwise, please tell me which hospital is giving away free service to the uninsured.

Exactly, these employees would take their children to the emergency room/urgent care. They weren't getting check-ups, but if the kid had a high fever, they would bring them in, get them seen by a doctor, then be on their way. When asked about billing they simply said "I don't have insurance". Many hospitals, including the DSH (disproportionate share hospitals) write these things off all the time. The hospital just do…

Here in San Diego going to the ER without insurance costs a minimum of $1,000. I once had to do so for my son. Cost for a room was $600, a $40 shin splint cost $250, and I am not sure what else but it was pretty expensive.

Re: Hospital creates bidding war by posting pricing online

#228

Post by steveplace » Thu, Jul 11, 2013, 3:44 PM UTC

swalkergibson wrote: post #135

steveplace wrote: post #48

Some other techniques off the top of my head: -- offer a "price match guarantee" against any procedures versus in-network hospitals -- offer a discount for low-risk patients (non-diabetic non-obese) who need to have surgery done -- do "bundle deals" with local hotels and/or attractions like they do with plane flights, so if you are travelling to the hospital you would have something for the family to do -- free 1-mon…

> offer a "retainer" that would lockin a price of any procedure for 5 years. Good for those who are family planning or have a low-priority surgery This sounds to me like an insurance premium, no?

This particular hospital is catering to the high-deductible crowd, so that's why I put that one in there.

Re: Hospital creates bidding war by posting pricing online

#229

Post by fizzbar » Thu, Jul 11, 2013, 5:05 PM UTC

sseveran wrote: post #213

fizzbar wrote: post #207

Earlier quoted context omitted.

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?!

The vast amount of technology available is turning healthcare into a luxury good. There are newer and better technologies for treating many things available. How much is that worth?

The technology should enable better outcomes. But the "good" in question here is your personal health -- its "worth" is infinite.

Re: Hospital creates bidding war by posting pricing online

#230

Post by Daniel_Newby » Fri, Jul 12, 2013, 1:42 AM UTC

estebank wrote: post #196

Daniel_Newby wrote: post #167

Earlier quoted context omitted.

> ... being treated for a heart attack, are situations where demand is completely inelastic. Not true. Even in a sprawling place like Oklahoma City, most of the middle class lives within safe transport distance of several hospitals. It would be perfectly rational for them to tell the ambulance crew to drive another five minutes to save $25,000. Most emergencies have plenty of time for price shopping.

>> ... being treated for a heart attack , are situations where demand is completely inelastic. > (...) It would be perfectly rational for them to tell the ambulance crew to drive another five minutes to save $25,000. I wouldn't want to be in your care. If you're having a heart attack you want to get into a hospital ASAP. And that's coming from somebody that took a taxi to the hospital after being stabbed in the chest…

Most heart attacks are small and not immediately life threatening. Some are dangerous but they tend not to be survivable anyway.

Most Americans wait over two hours to seek care for a heart attack! Cost is a big reason why—even a false alarm can cost several months of income. If people had the privilege of taking the time to comparison shop and drive out of their way for a good deal, they would probably get care faster.