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Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

medtechdive.com

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Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#81
post #75
post #57

Earlier quoted context omitted.

Always ask for the billing and procedure codes, also known as DGN, ICD10, and CPT/HPCPS Medical transcribing has a high error rate.

You're not wrong but this is a sign of a very broken system and the people least able to deal with it on even footing are people who may be in extreme pain or delirious from their injury. The US healthcare system is immoral.

It’s immoral and the broken complexity is by design.

Unraveled messes not to be fixed lest the profits disappear

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#82
post #2

Only in US that we don’t know the price of the health service we are redeeming. When I go get my car fix and I would go around to get an estimate for multiple body shop even if it is under insurance. But when it come to health care, you ask them for a cash price, they said they don’t know.

I feel like 80% of the healthcare logjam would be fixed if providers were required to 1. charge uniform prices for all payers and 2. present patients with written estimates based on said price schedule ahead of any non-emergency services, thus forming an actual contract. Note that mechanics don't particularly know what they're going to have to do to any given car before they really get into working on it. Yet the mar…

I'm not disagreeing at all (I'm not familiar enough with the system to disagree), just curious about your reasoning on uniform pricing for all payers?

The reason I'm curious is because using your car analogy, if I was a barely competent mechanic then management would probably be fine letting me perform oil changes, but when a classic Rolls Royce comes in with all original parts, management isn't going to let me touch that, right? They'll need to call in the big guns, whose rates are definitely higher than my "oil change" rate. I know that doesn't directly map with how medical procedures play out. I guess my real question is when and how does that balance out?

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#83
post #80
post #11

The US healthcare system is just a completely broken mess. When things go smooth, you are lucky! However, when you have a major procedure, life event or sickness things can get messy quick. We had a child 10 months ago, billing was screwed up by the hospital, then by insurance and we are still in process of getting it resolved. I have now spent at least 8 hours on the phone. I had a surgery, called insurance and veri…

The mess is by design. Goldman Sachs asks in biotech research report: ‘Is curing patients a sustainable business model?’ https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patie... >

> ‘Is curing patients a sustainable business model?’

this is some quote...

what's next: "people, what is their true ROI.."

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#84
Kaiser is the only non-broken part of the U.S healthcare system. They have never sent me a bill for a surprise out of network anything. Out of network doctors don't work there. All doctors are on salary. You get one bill from one company. No wonder they have been growing like crazy in California.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#85
Healthcare is such an asymmetric market that there will never be enough information for patients to price things accurately.

It's like if every road we drove on had a different toll every time we travelled on it, and we didn't quite know what the total would be (or what construction projects you might encounter along the way) at the end.

It's made worse by the high value people put on their health and their low knowledge of healthcare in general.

I worked in a hospital for 13 years, most of it on the billing and medical records systems. There was a single project I recall that tried to do price estimation for patients up front. It worked best for lab draws because a fixed number of vials were drawn for a finite number of predetermined tests. Anything beyond that involved human judgement at the time of service:

A doctor decides which X-ray views they want taken after seeing an injury, and may need to order more after the first results, and the radiology tech has some leeway in how they actually perform the imaging. A choice between X-ray, CT-scan, and MRI is pretty much an order of magnitude difference in costs between each, and determining whether an injury is bone, soft tissue, organs, etc. may require any or all of them.

Surgery is wildly unpriceable. The number of shots of anesthesia will differ for weight, metabolism, actual length of a procedure, and individual reactiveness to the medication, and the anesthesiologist may need additional medications to stabilize a patient's vitals. Each surgeon is making similar decisions as they go along; all of it has a cost and some tools/medicines are pretty expensive but no good surgeon will have price in mind during surgery; they'll use the best available method.

The article wants to blame insurance companies for price variation but that's a bit of a red herring. Every clinic and hospital does different numbers of various procedures and has different patient demographics so outcomes and severity will vary. ERs and cancer treatment are notorious cost-centers, whereas radiology services and outpatient procedures are the money makers. Hospitals and clinics have no choice but to pick and choose a set of services each year to raise or drop the prices for even before negotiating with insurance companies on actual reimbursement. Medicare and Medicaid also reimburse at (even lower) fixed rates so hospitals are always balancing costs for the number of commercially insured patients against government insured patients. Hospitals can't refuse emergency service to anyone, so they're also forced to eat the costs if they don't play the pricing game to cover ER and subsequent treatment costs.

The whole thing is a terrible mess and socialized healthcare is the solution.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#86
post #65

I've been ignoring surprise medical bills for 10 years, at least $10k worth altogether. None have reported to credit bureaus yet so I will continue to ignore letters.

I had a funny interaction with accounting, not for medical services but import.

I got billed extra taxes like 100$ (for a 80$ item), even though the seller said price included import fees to my country, so I bounced complaint emails all around to say no. After a while they stopped responding. Then 6 months later, lawyer official letter comes in. Threats of legal action.. I do the same email bouncing to them. After a while I suggested I paid 20$, the guy handling my case asked me to confirm that, a week later they sent me a new bill with 100$ fees and 80$ rebate.

There's no ground in their actions, at any point some dude can edit the documents and consider the issue resolved.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#87
post #76

Earlier quoted context omitted.

The intent is to maintain status-quo despite evidence that it's a broken system for medical users. Profits are being made based on the system we have. It's boards & c-suite executives keeping their fiduciary responsibility to their investors by lobbying against structural change. The intent is clearly there.

The intent is socially entrenched though - it's not just c-level executives calling for keeping the government out of healthcare. America has a real problem with anything that even smells like socialism or egalitarianism.

Anybody who thinks the US government isn't already neck deep in health care should just be disregarded out of hand.

It's literally a preposterous thing to believe, deeply revealing.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#88
post #80
post #11

The US healthcare system is just a completely broken mess. When things go smooth, you are lucky! However, when you have a major procedure, life event or sickness things can get messy quick. We had a child 10 months ago, billing was screwed up by the hospital, then by insurance and we are still in process of getting it resolved. I have now spent at least 8 hours on the phone. I had a surgery, called insurance and veri…

The mess is by design. Goldman Sachs asks in biotech research report: ‘Is curing patients a sustainable business model?’ https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patie... >

Should we be upset that people can't afford to provide cures we don't want to pay for?

When I work, I get paid. I expect pharmaceutical companies feel the same way.

And if you look at how the world dealt with the hep c cure, it was pretty much trying as hard as possible to pay as little for a cure because the cost was front loaded.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#89
post #29

When I lived in Italy, I once went with private care for a thing I wanted taken care of same day. I called, and they told me all the prices. I think I paid something like 120 euros out of pocket for a chest X-ray and consultation with an ENT specialist. The US health care system is so screwed up.

Same goes for Germany. The prices for doctors are fixed, so you can kinda look up how much a treatment would cost.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#90
This was a key thing that needed to happen for a long time. Insurance companies had no bargaining power with hospitals and price opacity helped secure that leverage for the hospitals.

This is the only sensible thing I can recall to emerge from the Trump administration and it is a much bigger deal than most people realize.

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