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I really like this push towards transparency but hopefully people who use the data / develop will make sure to understand the system and the data they're dealin
by aaavl2821 9y ago
I really like this push towards transparency but hopefully people who use the data / develop will make sure to understand the system and the data they're dealing with. Like list prices are often incredibly far removed from the actual dollars paid, and the actual amount paid is all dependent on insurer contracts
I'd imagine hospitals hate this. Many of them are paranoid at what will happen if there is more transparency -- there's a union fighting Stanford hospital now and playing radio ads about high infection rates at Stanford. Other hospitals are worried about whether similar things could happen to them -- and hold their data tight to make sure no one has ammunition to do similar things. Hospitals in many cases market based on brand value rather than quality. In a closed world, hospitals can define quality any way they want. Everyone is #1 in something. If there's an objective standard for quality based on integrated data from hospitals nationwide, many brands will be tarnished. I'd be interested to see how hospitals respond to this push towards openness
- octorian 9y ago> Like list prices are often incredibly far removed from the actual dollars paid, and the actual amount paid is all dependent on insurer contracts Which means that anyone those insurer contracts don't cover, is getting royally screwed. Thus, healthcare is simply unaffordable to someone who doesn't have those insurers acting as a payment intermediary. This one of the dirty secrets of the whole US healthcare coverage problem that I never see politicians (or talking heads) on either side actually acknowledging.
- killjoywashere 9y ago> politicians (or talking heads) If you're serious about learning, stop listening to these people (seriously, it's a waste of your one precious life) and try taking a healthcare economics class or reading Paul Starr's Social Transformation of American Medicine.
- octorian 9y agoThe problem is that these people dominate the public conversation. We can't solve a problem if you have to read some special book or take some special class to even be able to correctly acknowledge it.
- xivzgrev 9y agoRight. Hospitals have to deal with a mess of insurance plans. If they Underbill they only get what they bill. If they overbill there is no penalty they just get paid the allowed amount. So they jack up the prices to ensure they are always over billing. This works for insurance patients but then people without insurance or high deductibles get screwed.
- ams6110 9y agoYou can negotiate to settle your bill if you don't have insurance.
- crankylinuxuser 9y agoI dont walk into a Walmart or Target, load my cart up with stuff, have it scanned, walk out the door, and receive a bill 1-12 months later demanding all money paid in full in 30 days. This "negotiation" you mention works 1. If you know the price up front 2. have the leverage to negotiate. And guess what, you have neither of them. This law changes one of those, so that shopping around is at least possible. Aside: I'm surprised a lawyer didn't sue a hospital over Informed Consent via no billing knowledge.
- mynameisvlad 9y agoNot really, there's another comment thread in this post alone which talks about getting a 35% discount just for paying on the spot. It's ridiculously easy to negotiate because the prices are already so inflated that the hospital isn't losing money by offering "discounts" like that.
- crankylinuxuser 9y agoWhich is funny you mention that... If you don't know the bill, they can't tell you the bill, and they have no way to get the bill until weeks later, how can they "negotiate" when nobody knows? Frankly, that claim sounds like a pile of you-know-what. My bet is they take your money, and then bill you for the rest.
- maxerickson 9y agoPulling people into the insurance system was the whole point of the ACA subsidies and Medicaid expansion. It's a pretty clear acknowledgement of the problem. Whether full coverage should be something the government works on as policy and whether subsidized private insurance is the best way to get to full coverage are different questions, but the most talked about parts of the ACA directly address people in that insurance gap.
- Someone1234 9y agoIt is extreme, but banning all insurance discounts would be a good first step. This might concern people initially (because the discounts are currently so high) but for practical reasons after the ban is in effect the costs will go back to more or less pre-ban levels, but now simplify billing (reducing costs) and benefit people without insurance (no more absurd inflated bills). Insurance discounts themselves are problematic, and also result in this silly "in-network" "out-of-network" system we have. In particular where you could go to an "in-network" hospital but get an "out-of-network" anesthesiologist or lab giving you care without warning.
- kendallpark 9y ago> Like list prices are often incredibly far removed from the actual dollars paid, and the actual amount paid is all dependent on insurer contracts. Exactly this. The numbers that hospitals bill are largely fictitious compared to cost of care. What a lot of people don't realize is that hospitals use inflated billing from paying patients to cover the costs of uninsured patients that the hospital is required by law to treat in the ER. A lot of people against socialized healthcare don't realize that the system still takes extra money from those that pay and gives it to those that can't--just through hospital billing.
- danharaj 9y ago> A lot of people against socialized healthcare don't realize that the system still takes extra money from those that pay and gives it to those that can't--just through hospital billing. It would be refreshing to have a conversation with someone who holds such a position that was willing to say that hospitals should turn uninsured and poor people away at ERs and let them die in the streets. Its at least more honest.
- mikeash 9y agoI’ve been saying for a while that until and unless people start advocating for the repeal of EMTALA (the law which requires ERs to treat everyone), there isn’t any debate over whether we should have socialized medicine, merely over how.
- maxxxxx 9y agoWhat really needs to be published are the actual prices paid.
- coredog64 9y agoIf you take Medicare, it is illegal to charge anyone else a lower price than what you charge Medicare. Therefore these prices will be the floor and nothing else.
- positr0n 9y ago> Like list prices are often incredibly far removed from the actual dollars paid, and the actual amount paid is all dependent on insurer contracts. I just had $5k worth of bills from the birth of my last child (the amount wasn't surprising, pretty much exactly what the insurance estimated for standard pregnancy). I called, credit card in hand, and asked if they have any discounts for paying on time. They gave me a 35% discount on the spot! It still feels vaguely like insurance fraud because the $5k amount is what is going towards the deductibles...
- pishpash 9y agoThink of it this way, if $3250 is going towards deductibles all the time, your deductibles and other insurance costs would also be lower by 35%.
- jfoutz 9y agoI haven't looked at it in a couple of years, but medicare used to publish what they pay, and the random adjustments based on location and other factors i don't recall. medicare doesn't negotiate. they just pay a fixed cost up front.
- epmaybe 9y agodata is still on the CMS website: https://data.cms.gov https://data.cms.gov
- gowld 9y agoYou mean because insurance quotes your copays as % amounts, not $ amounts?
- positr0n 9y agoYes I think that's what I mean. We have a $5k individual deductible. After a deductible is met, we pay 20% coinsurance. Before the deductible we pay 100%. Making up some numbers, my wife had already spent $3k on the OB-GYN which counts toward the deductible. The hospital billed us $7500. So $2k we pay to finish meeting the deductible and then 20% of the remaining $5500 is $1500, so our portion of the hospital bill is $3500. If the insurance company knew we'd get a discount on our portion of the final bill, that calculation for how much of the bill we'd only have to pay 20% of would be different.
- sailfast 9y agoI would argue that there will be no push toward accurate cost of care unless some messy steps towards transparency are taken first. Union pushes infection rate data? Counter with your own data. Someone saying you’re too expensive? Counter with real dollar figures. More data! Right now we kinda just have to take people’s word for it. This transparency is the first step needed to move us toward smarter consumption of care. I don’t see any worthwhile brands getting tarnished by pricing data. If consumers see a hospital as expensive, they might choose a cheaper hospital that provides the same standard of care without the frills. This is the kind of decision making that will bring down care costs over time and I’m stoked to see this move.
- aaavl2821 9y agoI totally agree, transparency has the power to really move the needle. The issue I see though is that all parties that have data are incentivized to keep it to themselves. Many "leading" hospitals actually don't have super great quality compared to other, less well known hospitals. So powerful, well known but low quality hospitals will lose if there's more transparency. They know this, and they're fighting it Large EMRs will also lose if there is more interoperability. Right now the fact that Epic and Cerner "own" a hospitals data gives them a lot of power. If anyone wants data, they have to go not just through the hospital, but through the EMR duopoly. Insurers don't want to publish their rates, because they'd face backlash from all around when people realize how much variability there is in how much they pay for the same procedure at different hospitals
- nradov 9y agoUnder the 21st Century Cures act, the federal government has now started prohibiting information blocking by EMRs. There are still some obstacles and friction but generally Epic, Cerner, and their competitors are opening up and offering published APIs using standard protocols.
- OliverJones 9y agoIt's unfortunate that union actions against hospitals often try to scare the public -- the patient base -- into staying away. Such actions have been known to backfire. Where I live an electricians' union tried this, and it generated ill will towards the union and good will towards the hospital.
- ktosobcy 9y ago> Like list prices are often incredibly far removed from the actual dollars paid, and the actual amount paid is all dependent on insurer contracts I had a "pleasure" to actually dig for some service (online) and after a while I got frustrated by this exact thing - all prices are always hidden, you HAVE TO contact 'sales' department and even if they show some prices upfront there are sooo many hidden costs and obligatory services and taxes that it's virtually impossible to quickly compare services. In contrast - in majority of the European countries (I think it's an EU thing) all companies are obliged to display complete, total price for customer with all taxes included - this makes life so much easier…
- chimeracoder 9y ago> I'd imagine hospitals hate this. Not as much as you might think. The biggest beneficiary of price opacity is, actually Medicare itself. Because prices are opaque, and because it's illegal to charge private insurers less than what you charge Medicare, and because Medicare has no legal mandate to reimburse COGS, Medicare is able to use the lack of price transparency to force providers to pass Medicare costs on to private insurers (which then gets passed on to privately-insured patients in the form of premiums). A rather cynical - but wholly plausible - view of this news is that it's an attempt to undermine the long-term financial solvency of Medicare, by making it harder for them (in the long run) to pad their operating budget this way. Given that the press release heavily emphasizes the role of the current administration in making this change[0], and that the entire party has pretty consistently supported cutting funding for Medicare[2], it's a rather easy conclusion to come to. [0] It's not exactly unusual to mention the President by name in a press release of this nature, but it's not exactly typical or standard practice either. Oftentimes, agencies will refer to themselves as if they were politically neutral and functioning somewhat independently of the executive branch[1], even though the leadership is obviously appointed by the executive. [1] Because, to a large degree, they are - the people employed by these agencies have relatively low turnover, unlike the directors who are appointed fresh by each new administration. [2] Not in their rhetoric, of course, but with their actions
- themagician 9y agoHow this isn't already mandated by law is baffling. We like to champion the "free market" but then completely fail to implement policies that make that even remotely possible. When people talk about the free market and today's healthcare in the US I'm always like, "What are you even talking about?" You've got a situation where there is typically no competition and little or no information available to the consumer. Free market economics simply don't apply. One of the reasons I like Kaiser is because the price for just about everything is posted. I know an CT scan of stomach area, with dye is $608. Every healthcare provider should be required by law to give you an estimate price on the spot. If it's too complicated because of multiple insurance providers and their contracts they should be forced to renegotiate in a way that make this possible. "It depends" or "we can't tell you until after we bill you" is not acceptable. Can you imagine any other market working that way? How much is this car? Can you imagine if the response was, "Well, it depends. We can't tell until after you agree to take possession. It's somewhere between $40 and $40,000. But it might actually be free if you submit form X, but you have to go back in time and submit it before you walked in the door and get it approved." If the option was universal healthcare vs a free market system there would at least be a discussion. Instead it's universal healthcare vs the roll-of-the-dice healthcare system we have now.
- chimeracoder 9y ago> How this isn't already mandated by law is baffling. It's not baffling if you look at the way the medical billing system actually works. In short, Medicare is able to use existing laws (the requirement that Medicare receive the lowest price, along with the lack of mandate to reimburse COGS) to force providers to use funds from privately-insured patients to cover the costs of treating Medicare patients. From a financial point of view, the biggest adversary of price transparency (for privately-insured patients) is Medicare itself. In that light, it's not surprising that an administration which has been very clear it wants to defund Medicare (without actually admitting as much in those words) is establishing rules that will essentially restrict the effective operating budget that Medicare will work with, long-term.
- dbatten 9y agoI'm glad to see someone else shares this view. I've been saying for years that both a single payer health system and an actual free market system would be preferable to the heavily-yet-poorly-regulated mess of a "market" we have now. If we don't go the single payer route, it seems one of the #1 things we could do is to help move "insurance" back to being actual insurance (i.e., we'll keep you from being bankrupted by your medical bills) rather than a system that highly subsidizes your regular medical care but then may not actually be there for you when the bills really pile up... If consumers had to actually shop for procedures (as opposed to knowing the out-of-pocket is $250 and who knows what happens beyond that), I think you'd start to see people screaming for transparency, and medical providers would have to get their acts together. Only one of many problems, I know.
- brandall10 9y agoRight, the real solution would be to have a listing of usual and customary costs per region. This is what people who offer advocacy services to the uninsured do. It's similar to getting comps on real estate, those people have access to billing systems to find out what insurers actually pay and negotiate based on that pricing.
- dalbasal 9y ago"list prices are often incredibly far removed from the actual dollars paid, and the actual amount paid is all dependent on insurer contracts" I think that fundamentally (or almost fundamentally) clashes with transparency.
- dragonwriter 9y ago> I really like this push towards transparency but hopefully people who use the data / develop will make sure to understand the system and the data they're dealing with. They won't. Having clear, sinple, unambiguous per-procedure price information widely available while quality information (including on induced downstream needs and costs) is less clear will produce strong downward pressure on quality, while also not controlling aggregate cost. That's a pretty clear pattern in human behavior that is often leveraged both as a competitive tactic and to increase total revenue.
- ickwabe 9y agoRe: "list prices are often incredibly far removed from the actual dollars paid, and the actual amount paid is all dependent on insurer contracts" Would be great if they were required to provide list, min insurer price, max, and median.
- emodendroket 9y agoBut if you're uninsured the list price is what you will be billed, isn't it?
- trumped 9y agoThe uninsured pay much less, specially if you have no catastrophic claims
- mirimir 9y agoBasically, Medicare and Medicaid are tired of getting screwed. When those programs were established, they were intentionally hobbled in negotiating prices with drug companies, hospitals, physicians, etc. Because, you know, it wouldn't be fair to providers. As a result, Medicare and Medicaid often pay more than private insurance. In part, that's because their ranges for negotiation are pegged to list prices. And so providers inflate those list prices. And nobody, except for a few clueless patients, actually pays list price. Anyway, good for Medicare and Medicaid!
- inputcoffee 9y agoList prices are meaningless but Medicare prices are probably the most meaningful. Insurance prices are benchmarked off them.
- Immortalin 9y agoI just started a project for this: https://github.com/PraecantatioLabs/Asclepius https://github.com/PraecantatioLabs/Asclepius Pull requests for your local hospitals are welcomed!