Earlier quoted context omitted.
When you remove the middlemen, what will you replace them with?
Tiny bits of software.
What's the purpose of the software?
Hospital prices are about to go public in the U.S.
231–240 of 390 posts
Re: Hospital prices are about to go public in the U.S.
#232Earlier quoted context omitted.
If you look at the actual household income in various countries, as opposed to the GDP, which doesn't always track household income as well for many OECD countries, it turns out that the US has pretty much the healthcare consumption expected for its average household income: https://randomcriticalanalysis.com/2018/11/19/why-everything... . Based on this analysis, I think the primary issue with US healthcare is the fa…
That's an interesting measure - wouldn't it be biased by the fact that household income in the US is "artificially" inflated compared to other countries, because healthcare costs need to be paid from income?
First, we can assess the degree to which the US is unusual by inspecting the scatter plot. If US household income was somehow unusually inflated by health spending, then it its residual should be much larger than it is (especially in better models that incorporate some of the non-linearity observed in other countries).
Second, just where is this extra income supposed to come from? More likely households bear almost all of the incidence of this spending, meaning each dollar spent on health means approximately one dollar less available to households to use elsewhere. This is certainly what the literature on employer health insurance benefits tends to suggest.
Third, the timing of this is all wrong. It’s clear the arrow of causation goes overwhelmingly from income to health spending because changes in health spending clearly follow changes in income. Over the past few decades it takes an average of about 2-3 years for changes income to be fully reflected in changes in health spending due to the large role played by 3rd party payers, employers, etc (the current year elasticity is about 0.2 whereas the long-term elasticity is north of 1.6).
~RCA
Re: Hospital prices are about to go public in the U.S.
#233The next logical step is to require written estimates in advance, just like the auto repair industry.
The reason you can get a written estimate is because there’s a big book the service writer flips to, “hmm, front swing arm bushings on a ‘12 Corolla: 2 hours. Front end alignment: 0.75 hours...” Worst case is, I get the acetylene torch out for those rusted-to-hell front end bolts, but it’ll take me about what the book says, usually less. Well, worst case is a bunch more front end parts are shot, waste of money to do just bushings, and customer doesn’t want to spend the money (after the requisite phone call). Bolt ‘er back together still broken, and send them on their way.
You figure out how to apply that same scenario to cardiac surgery, and you can have your written estimates.
Re: Hospital prices are about to go public in the U.S.
#234Earlier quoted context omitted.
> Doctors are well paid in the US but they are typically not rich. What doctors do you know? My friends who are just getting out of residency and such are making a few hundred thousand a year. My college roommate’s father was an anesthesiologist making $800k/year. Just because they don’t draw attention to themselves with ostentatious vehicles doesn’t mean they couldn’t afford to (the anesthesiologist only had a Porsc…
The first result on google (that I don't particularly vouch for) seems more in line with what I would expect: https://www.sokanu.com/careers/doctor/salary/ So between $200k-400k depending on seniority and speciality. It's not really outrageous compared to other, highly educated professions.
Not outrageous, but that puts all of them in the top 4% of US incomes, and after a decade or two of that basically all should be counting a few million in assets. That’s rich and far, far beyond average in this country let alone the world. Compare to other first world nations where doctors typically make half that (or less), but probably aren’t saddled with the unreasonable educational expenses.
Re: Hospital prices are about to go public in the U.S.
#235Pro tip: I was a neurosurgical anesthesiologist at the University of Virginia Health Sciences Center for twelve years (1983-1995). Every now and then I'd get a call from our billing office that they'd received a letter from a patient I'd cared for who was too poor to pay what our department had billed (usually many thousands of dollars: I had NO IDEA what our charges were, BTW, nor did any of my colleagues in the dep…
If you are a patient in this situation, there are advocates who can help you. One thing to try is to ask the billing department if they will "accept assignment". What that means is that instead of billing you their fake rate, they would instead bill you as if you were an insurer. IMO, it is incredibly unethical and dishonest for these medical corporations to charge different fees depending on who you are. Prices shou…
I've done that. Except I didn't know the words "accept assignment". I basically just said that I'd pay whatever they'd charge if I had insurance. So they could either accept that, or let it go to collection. And if they let it go to collection, I argued, they'd probably get less than the insurance price that I'd pay them.
And I got an adjusted bill.
Re: Hospital prices are about to go public in the U.S.
#236I wonder if the prices listed will be shown in a manner that is legible by the average citizen or if they will be so convoluted that no one will be able to make sense of them.
Reading the article it seems as this will be the case. Hopefully that changes down the road.
Re: Hospital prices are about to go public in the U.S.
#237Re: Hospital prices are about to go public in the U.S.
#238Pro tip: I was a neurosurgical anesthesiologist at the University of Virginia Health Sciences Center for twelve years (1983-1995). Every now and then I'd get a call from our billing office that they'd received a letter from a patient I'd cared for who was too poor to pay what our department had billed (usually many thousands of dollars: I had NO IDEA what our charges were, BTW, nor did any of my colleagues in the dep…
My experience is that hospitals have switched to a zero tolerance policy around this in the last few years. They'd rather make no concessions and sell bad debt for pennies on the dollar than set a precedent that there are alternative channels of payment. The one lifeline they give you is an interest free loan. From an economic standpoint, I'm sure this optimizes revenue. From a humanitarian standpoint, it's disturbing. I'm not arguing healthcare should be free or discounted, but when you receive a $500 bill because the on-call ambulance wasn't in network (though the others are in-network and would have cost you $50) it is hard to justify zero tolerance. We have a gold plan and I can't count the times we've been subject to loophole fees like this.
Re: Hospital prices are about to go public in the U.S.
#239Earlier quoted context omitted.
Are people really billed based on diagnostic codes? If true, it’s not what ICD-10 was designed for. Patient A can recover from the same procedure for the same diagnosis much quicker and with fewer interventions than Patient B. Would insureco get billed the same for both?
They aren't. Prices are based on the HCPCS codes (CPT for clinical charges). For example, a 99213 is a return office visit.
Providers often enter ICD-10 codes (required by Epic) and do not know HCPCS or CPT... so how could they tell you what you will be charged? There isn't a way (that even educators know of to get those codes or the pricing)... the prices are handled by billing, which is a separate department and you can't reach them by phone. They will call you back (within 30days), but they do not leave messages.
Clinic and hospital in the heart of silicon valley.
Re: Hospital prices are about to go public in the U.S.
#240For someone who worked on price transparency in 2013 - I was personally affected with surprise billing - and spent long hours working on a price discovery / transparency tool called pricepain.com, this (first step of an) anti cartel measure brings tears of joy. While it won’t solve all issues at once, shining some light into the medical billing mess can only be a good thing, allow market forces to enter the picture s…
Something I worry about, and that maybe you can help shed some light on, is what the ramifications of such a move would be. You mentioned the grading of schools leading to higher quality. Do we know if any metric suffered as a result? One guess I have is that teachers started teaching for the test rather than for the foundation. Take that same question and apply it back to the issue of hospital cost. If there's more…
I suspect that with teachers teaching to a test, it improves bad teachers and holds good teachers back a little.