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

Re: Hospital creates bidding war by posting pricing online

#71

Post by redler » Tue, Jul 09, 2013, 9:10 PM UTC

crusso wrote: post #31

HarryHirsch wrote: post #25

Earlier quoted context omitted.

> I dream of a day when I can walk into an area which offers 'services' and be offered a pricing chart. I don't want to be offered a pricing chart when I have a kidney stone or get violently mugged. When that happens I don't want to have to deal with that sort of thing. The free market in medicine is plain weird. Everyone needs the doctor on occasion, and everyone needs tyres on their car. Both things are pretty stan…

The free market in medicine is plain weird Says you. Time and again, Lasik surgery and cosmetic surgeries not covered by insurance or hindered by over-regulation have shown us that transparent pricing and competition work to make those procedures more affordable -- just like these forces work in other markets. The State has perverted the medical market for more than half a century and you're just used to seeing it in…

It's also important to consider that Lasik and cosmetic surgeries are elective procedures characterized by elastic demand. Having a trauma surgeon remove a ruptured spleen, or being treated for a heart attack, are situations where demand is completely inelastic.

One might shop around for the best way to spend a spare $10,000 for an eye lift, but who can be expected to shop for an economically satisfying deal while in a life-threatening situation? Reducing regulation would not change this essential qualitative difference.

Re: Hospital creates bidding war by posting pricing online

#72

Post by crusso » Tue, Jul 09, 2013, 9:11 PM UTC

mikeyouse wrote: post #35

crusso wrote: post #31

Earlier quoted context omitted.

The free market in medicine is plain weird Says you. Time and again, Lasik surgery and cosmetic surgeries not covered by insurance or hindered by over-regulation have shown us that transparent pricing and competition work to make those procedures more affordable -- just like these forces work in other markets. The State has perverted the medical market for more than half a century and you're just used to seeing it in…

Lasik and Cosmetic surgeries are minimally invasive elective procedures that can be researched months ahead of time, it doesn't make much sense to compare them to major surgeries or even severe infections.

Yeah, so is a vasectomy yet when I went in to get a price on a vasectomy from various doctors, none of them could tell me how much one would be despite each doctor's having performed thousands of them.

Doctors, hospitals, and insurance companies play these obfuscation games in order to maximize revenues and profitability.

Removing unnecessary actors from the equation like employers and making pricing publicly visible would do wonders to reform the system.

The fact of the matter is that most surgery isn't emergency surgery. Most procedures can be researched and cost compared.

Even for semi-emergencies, illumination of pricing and other vital information would allow better decisions from consumers who at least knew the reputation of hospitals/providers in their area. I don't know how much a banana costs just now, but I know that if I need a really inexpensive one of dubious quality I can go to the super WalMart down the road. If I want a super fresh one that's probably more expensive, I can go to Whole Foods. If I want a "good enough" mid-price one, I can go to Publix.

Re: Hospital creates bidding war by posting pricing online

#73

Post by sbercus10 » Tue, Jul 09, 2013, 9:13 PM UTC

pdx wrote: post #45

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…

Pricing transparency, for whatever reason, does not exist as a rule in the medical industry. The "charge masters", are a joke that the hospitals themselves admit are useless as indicators of actual prices paid unless you're out of pocket, and then you get to pay them. Even then, the charge masters, as useless as they are, are still kept well hidden from all but the most inquisitive. I hope you're right about the gove…

If this topic is at all interesting to you, you should read Steven Brill's dissertation in TIME titled "Better Pill" from a few months ago. Since TIME has a paywall, here is a link to the PDF of the article:

http://livingwithmcl.com/BitterPill.pdf

Re: Hospital creates bidding war by posting pricing online

#74

Post by toomuchtodo » Tue, Jul 09, 2013, 9:14 PM UTC

ahallock wrote: post #51

toomuchtodo wrote: post #28

Earlier quoted context omitted.

Fine. Sure, you bump your head or get a sore throat, you walk it off. What happens when you try to "walk off" something you think is minor, and you're in the ER 24-72 hours later? Hello $20K-$50K bill. My wife and I were in a car accident a year ago (someone turned in front of us while we were doing 40mph). My wife required an ambulance for transportation due to damage to her right foot. The ambulance didn't exactly…

That's what insurance is for. Catastrophic situations. Or perhaps there's a way to pre-purchase emergency care at a discount. Or you set your emergency provider ahead of time based on price. I don't know. There must be creative ways to solve this problem rather than being all fatalist about it.

Counterpoint: At the time, we had insurance. Great insurance through Blue Cross Blue Shield. Also, had State Farm for auto. Our medical policy on our auto policy was exhausted solely from the hospital visit and ambulance ride, and the other at-fault party's coverage (also State Farm) barely covered the first few doctor visits for my wife.

I've now had to pay several thousand dollars out of pocket for my wife's physical therapy, MRIs, and prosthetics, and have been told I will need to sue State Farm to recoup my out of pocket expenses.

Re: Hospital creates bidding war by posting pricing online

#75

Post by DavidAdams » Tue, Jul 09, 2013, 9:15 PM UTC

MattBearman wrote: post #29

ambiate wrote: post #14

I dream of a day when I can walk into an area which offers 'services' and be offered a pricing chart. From hospitals, banks, loan officers, home loans, cars, etc. A cryptic itemized list, such as a mortgage's Good Faith Estimate (GFE), which falls short of describing the items in the list still fails my test. This hope is not for me. Its for the misfortunate who run on impulse and have weak mathematical logic. Many p…

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…

The shenanigans the commenter is outlining is probably an attempt to make sure that the landlord can ensure that there will be enough minor charges at move-out to enable them to keep the entire security deposit. It's shady and probably wouldn't hold up in court, but most renters wouldn't fight it and would just forfeit their deposit.

Re: Hospital creates bidding war by posting pricing online

#76

Post by lostlogin » Tue, Jul 09, 2013, 9:17 PM UTC

Mercy Hospital charged $16, 244 for a breast biopsy; the procedure will cost $3,500 at Surgery Center of Oklahoma.

WTF?!? I don't know what we charge for a routine biopsy, but for an MRI guided one with vacuum assistance - vasty more complicated, expensive and time consuming - we charge about $2000USD. Come and have a holiday in New Zealand at the same time and it may still be cheaper.

Re: Hospital creates bidding war by posting pricing online

#77

Post by showerst » Tue, Jul 09, 2013, 9:18 PM UTC

rthomas6 wrote: post #67

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…

You and the article seem to be saying totally contradictory things. Was the article just outright lying, or is there some nuance I'm missing?

I don't think the article was exactly _lying_ as putting a spin on the truth to make a political point.

What they did is totally cool, and more providers should post their pricing transparently. There are complicated, sensible reasons not in the current world, which I hope will change.

The government does not obviously stop them from providing pricing information about how much they charge for medicare/medicaid, hell the gov't releases that info themselves for the really big providers. It is, however, their business and I'm _sure_ they could point to some of the thousands of regulations and laws they operate under and say that it realistically prevents them from releasing pricing. It's like when people who haven't done so say they won't start a business because taxes are too high. Not false, but politically laden.

Saying that they don't take medicare/medicaid so that they provide a higher standard of care or be more successful or whatever is kind of like saying "Our private school doesn't accept kids who get reduced price lunches, so that it can operate efficiently and provide the best education."

It's not _lying_ so much as blatantly spinning it. This just feels like when you see a tech site re-run a breathless press release verbatim. It's not _false_, but it's not exactly fair to readers, either.

Re: Hospital creates bidding war by posting pricing online

#78

Post by Amadou » Tue, Jul 09, 2013, 9:19 PM UTC

rthomas6 wrote: post #67

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…

You and the article seem to be saying totally contradictory things. Was the article just outright lying, or is there some nuance I'm missing?

A couple of months ago, Time magazine (of all places) did a really good story about the lack of price transparency in healthcare and how that may well be the single largest contributor to the burgeoning healthcare costs in the US. I think it is behind a paywall, here is a starter though:

http://www.time.com/time/magazine/article/0,9171,2136867,00....

In a stunning example of competence and efficiency, the US government responded to that article by publishing a ton of medicare pricing information on a hospital by hospital basis. Here's one article discussing the data:

http://www.boston.com/lifestyle/health/blogs/white-coat-note...

FWIW, as a person who has been using catastrophic insurance (e.g. super high deductible) for over a decade I find this move to more price transparency long over due. I've had the experience where some practitioners simply refused to take cash up front, it was insurance or nothing while others would give a significant discount, like over 50% for cash up front. We've still got a long, long way to go, but it's a start.

Re: Hospital creates bidding war by posting pricing online

#79

Post by lettergram » Tue, Jul 09, 2013, 9:21 PM UTC

showerst wrote: post #27

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…

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 $8,000.

Also, just so everyone knows, it's pretty easy to negotiate down your bill. The reason healthcare is so expensive is so many people don't pay it. If you are willing to pay say 40% of your bill it's already 25% better than medicare.

Re: Hospital creates bidding war by posting pricing online

#80

Post by msandford » Tue, Jul 09, 2013, 9:24 PM UTC

toomuchtodo wrote: post #6

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…

All this is of course due to political circumstances: medicine is just too profitable. No. Medicine in inelastic. There is no such thing as a rational demand side, as you don't get to choose if you need healthcare or not. When demand is inelastic, and supply is limited, prices will rise accordingly with no relief in sight. The solution? Either set market prices (at the cost of stifling supply) or flood the market wit…

> No. Medicine in inelastic.

Fantastically incorrect! A good portion of medicine is elastic. If you have the sniffles you don't NEED to see a doctor but many people choose to because they can. If you tear your ACL you don't NEED surgery to continue to stay alive but you sure do WANT it.

Furthermore let's just suppose that the demand is fixed and won't change. Demonstrably false but let's just try. Okay. Publishing of prices can still shift that demand from one particular vendor to another depending on price. Just the same as the demand for TP is largely fixed but purchases can be shifted from Target to Wal-mart to Costco depending on price.

Very, very few illnesses are so outrageously life threatening that they have to be performed RIGHT NOW at WHATEVER hospital you're at. That's mostly limited to trauma type stuff from accidents of various kinds.

For everything else like seeing the doctor for the flu, broken bones, joint problems, diabetes, heart disease, etc etc etc you could certainly spend 15 minutes on the internet. And for many of those things you could afford to spend a whole weekend or three if you wanted. For example once you've got an insulin prescription for the next X days/weeks/months you've got tons of time to shop for a doctor that you would like, or who offers a better price, etc rather than the first doctor you can manage to get yourself to.