Business practices would have to change. In cases where the all the steps and treatments aren't knowable up front, providers would have to pick a price and stick to it - like any business or service provider they'd make money on some and lose money on others. Instead of issuing separate random bills from various providers, hospitals would have to pay their subcontractors out of their fixed prices, like a normal business. There may be exceptions for emergency care but those would be the rare exception, not the rule.
I analyzed hospital price lists so you didn't have to
361–370 of 403 posts
Re: I analyzed hospital price lists so you didn't have to
#362Frankly, this exercise motivates me toward universal care more than ever. I do not mean to devalue the work. It's great honestly! Thank you. That said, this is a major league mess most of the world would look at and wonder whether we are crazy or high.
Yes, as someone outside the US, the fact that this is a thing is just... weird. When I go to the hospital I'm already worrying about health, I'm thankful I don't have to worry about money too.
Right now, it appears the US will have to learn this all the hard way. The financials are super attractive for people at the business level, and can be compelling for care providers, who may have expensive school to pay down.
For most everyone else, including many employers, it is increasingly painful.
The nature of the issue also makes change hard. Many people do not want to disturb what is working for them however painful. Can't blame them.
Re: I analyzed hospital price lists so you didn't have to
#363Earlier quoted context omitted.
I really want to expose Stanford's ridiculous billing and shame them to no end, but I don't have enough Twitter followers. I know healthcare billing in the US is f-ed up but Stanford is particularly bad.
Not sure you need to expose them - everyone is pretty much aware it’s a shitshow. Not only in billing but quality of care and treatment of staff also
Re: I analyzed hospital price lists so you didn't have to
#364Earlier quoted context omitted.
Not exactly: In 2019: "Specifically, we updated our guidelines to require hospitals to make available a list of their current standard charges via the internet in a machine-readable format and to update this information at least annually, or more often as appropriate." [1] Which is part of this executive order that Trump signed: "Within 60 days of the date of this order, the Secretary of Health and Human Services sha…
> (e) STANDARD HOSPITAL CHARGES.—Each hospital operating within the United States shall for each year establish (and update) and make public (in accordance with guidelines developed by the Secretary) a list of the hospital’s standard charges for items and services provided by the hospital, including for diagnosis-related groups established under section 1886(d)(4) of the Social Security Act. Signed 2010, PATIENT PROT…
Or are you implying everyone just ignored it for 12 years?
Also, Trump's order is significantly larger than what's in the ACA, and Trump actually implemented his order.
You can give Obama credit for trying, but Trump gets credit for actually doing it, and for doing it much better than Obama.
Re: I analyzed hospital price lists so you didn't have to
#365Wrote 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…
Re: I analyzed hospital price lists so you didn't have to
#366Earlier quoted context omitted.
I posed my question to warrant a discussion from either the commentary or faithful statement regardless of their intent. Mainly to understand the expectations, values, and reasoning.
I don't think the concept is lost on any half intelligent adult that running a hospital has expenses and has to be paid by someone. The commentary is accurate that's is messed up to have a "price", like something is being sold. Having hospitals run off funding by taxpayers isn't a price any more than the military buying an F35 having a per-American price (and no one thinks of it that way)
Services are being sold, whether it's private or government ran.
> Having hospitals run off funding by taxpayers isn't a price any more than the military buying an F35 having a per-American price (and no one thinks of it that way)
It is a price, so is the F35, and yes more people should think that way. Whether it's being paid for via taxes collected or paid directly is irrelevant.
The problem is not the method of collection of payment (taxes or direct) but the corruption of administrators.
Re: I analyzed hospital price lists so you didn't have to
#367Earlier quoted context omitted.
> It bears questioning how, in ”the richest country on Earth”, something as important as a hospital ends up held together with spit and twine. In less rich countries they use paper records, which are worse. Everything is held together with spit and twine.
There's a lot of this concept, that if it doesn't work in the US, everybody else must have failed even worse. Well, not really, many times it's actually the other way around. I won't bother with other more obvious examples but in this context, even Pakistan has a digital health system in the meantime.
Of course many countries are worse, but surely you want to look at successes of others and replicate them.
Re: I analyzed hospital price lists so you didn't have to
#368Earlier quoted context omitted.
In France, the pharmacist is legally obliged to offer the cheaper generic. If the doctor wants the primary brand specifically, he has to write "non-substitutable" on the prescription and a shorthand mention of the reason.
"Non-substitutable -- otherwise I won't get my kickbacks"
Re: I analyzed hospital price lists so you didn't have to
#369Earlier quoted context omitted.
Yeah. A lot of flamewars have happened: "regulation bad!" vs "no, regulation good!". But in reality, good regulation is good, and bad regulation is bad. It sounds silly written out because it's a tautology, but if more people internalized it we could have much more productive conversations. Instead of going back and forth on whether regulation is good or bad, we should try to figure out which regulations are good and…
>But in reality, good regulation is good, and bad regulation is bad. No one brick in the road to hell is bad. But you can definitely pave a road to hell with the accumulation of "positive" changes. People tend to define positive over too short a timeline or too narrowly.
Re: I analyzed hospital price lists so you didn't have to
#370>Require a standard format. Pick JSON or CSV in some standard encoding. We don't need hospitals publishing XML files and Excel spreadsheets. Definitely CSV. Always CSV. It's easy to produce, easy to parse, and kind of human readable. And easy to do some basic analysis with tools that everyone has access to - Excel, Google Sheets etc.
I didn't like CSV because too much actual data has commas in it, so commas aren't a good delimiter.