7 ms·

This whole practice should be illegal, why can't hospitals list the materials they used, their cost and how many hours doctors and nurses worked and what they b

This whole practice should be illegal, why can't hospitals list the materials they used, their cost and how many hours doctors and nurses worked and what they bill hourly? The cost for a hospital to do a procedure doesn't changed based on my insurer, so they shouldn't be able to charge differently.

refurb 8y ago
Cost accounting. Hospitals are terrible at it. Even if you asked the hospital, how much does it cost to take an x-ray? Personnel, capital costs, material costs, everything. Most hospitals couldn’t tell you. They tend to measure based on service lines. “Our stroke unit is profitable”. Beyond that, they are pretty hopeless from what I’ve seen.
- derefr 8y ago
  It'd be interesting to build a private hospital from the ground up to run on a cost-plus business model (and then refusing to negotiate with insurers because your rates are already reasonable; or, alternately, after figuring out what you "want to" charge, setting a 30x top-line multiplier on that so that insurers can't complain that they don't have the cheapest rate; and then giving everyone besides them an automatic 30x "negotiated" discount, with the negotiation occurring between the hospital and a patient ombudsman before the patient ever arrives.)
  - nicoburns 8y ago
    I wonder if you could even sell your own direct to consumers insurance. That would be one way to shake up the US healthcare market, but it need a hell of a lot of initial investment.
  - pg_bot 8y ago
    I started a healthcare company and we set up the business so that patient tests, and procedures are not profit centers for the company. We make money off of a recurring subscription model, (direct primary care) and publish all of our prices upfront. We negotiate rates with local providers on your behalf and do not mark up their pricing. People need to stop expecting that their insurance should cover literally everything. Medical billing is usually around 40-50% of the total overhead for running a clinic. You can get rid of that entirely if you switch to a cash model.
    - derefr 8y ago
      > People need to stop expecting that their insurance should cover literally everything. Well, yes; in countries with public healthcare, there's still stuff that your coverage doesn't pay for (e.g. voluntary stuff like removing a mole.) But that uncovered stuff, in those other countries, still tends to be far less expensive than the equivalent service costs at even private "cash only" clinics in the US.
      - pg_bot 8y ago
        We tend to treat a lot of things as equivalent just because we have some statistic that we can use for comparison. I know it may sound shocking to some, but paying more does not necessarily mean that something is wrong. If I want a private hospital room, I want the services of a doctor that is in high demand, I want to use the latest technology, or I want something done faster and am willing to pay freely shouldn't I be able to? All of those things cost money, but are not accounted for when we are looking at the stats. You have to break things down into smaller pieces and figure out why things are more expensive before you can truly make an accurate comparison.
- 2trill2spill 8y ago
  That's 100% the hospitals fault, no other profession would get away with not knowing how much the service they provided you costs and then making up a number to charge you.
  - kazen44 8y ago
    how come the US is so opaque about pricing? Any other country i have been to (national insurance or not) has been absolutely transparent about pricing of healthcare. Including a GP in a tiny village in france who didn't speak english who sew back the skin on a finger after a nasty cut. (i had to pay a fee because i am not a french person, and the EHC doesn't cover "mundane" injuries like a deep cut in your finger.) the healthcare system in the US seems like total chaos to me.
    - vidanay 8y ago
      We aren't even transparent about the cost of buying a candy bar at the convenience store.
  - refurb 8y ago
    Agreed! If you asked a Vision Correction clinic or cost metic surgery clinic the same question, I’m sure they could give you an exact answer. Simpler business model albeit.
- rendall 8y ago
  "Cost accounting. Hospitals are terrible at it." Which is the more reasonable explanation? A hospital does not tell a patient the cost of an x-ray upfront because: a) the hospital is terrible at accounting OR b) the hospital makes a higher profit by withholding or obscuring that information until after the procedure.
  - wswope 8y ago
    I work in a hospital radiology department, and the main part of my job is cost accounting. Getting estimates of cost for medical procedures is surprisingly difficult and expensive. It takes many people many hours of work to figure out how much a specific set of procedures costs. Bureaucracy also makes the job far harder than it should be, but "moving fast and breaking things" can lead to people dying, so it's understandable why hospitals don't tend to be innovative enterprises. There is value in it, but at the same time hospitals don't have much incentive to lower costs. My job probably only exists because medicare/medicaid bundled payment schemes are finally forcing hospitals to look at costs. Basically, it's both A and B.
prostoalex 8y ago
> doctors and nurses worked and what they bill hourly Those guys are typically salaried, and that's likely one unknown. Another one is the legislatively imposed obligation that they provide [expensive] ER services to anyone who walks in regardless of insurance coverage requiring the hospital to potentially eat up the cost.
- thaumasiotes 8y ago
  Doctors are typically salaried; it was my impression (my mother is a doctor) that nurses are typically hourly. At least, she always quotes nurse rates as hourly.
- amanaplanacanal 8y ago
  I wonder how much those free ER services actually cost. It comes up in conversation, but is it 1% or 50%?

refurb 8y ago

Cost accounting. Hospitals are terrible at it. Even if you asked the hospital, how much does it cost to take an x-ray? Personnel, capital costs, material costs, everything. Most hospitals couldn’t tell you. They tend to measure based on service lines. “Our stroke unit is profitable”. Beyond that, they are pretty hopeless from what I’ve seen.

derefr 8y ago
It'd be interesting to build a private hospital from the ground up to run on a cost-plus business model (and then refusing to negotiate with insurers because your rates are already reasonable; or, alternately, after figuring out what you "want to" charge, setting a 30x top-line multiplier on that so that insurers can't complain that they don't have the cheapest rate; and then giving everyone besides them an automatic 30x "negotiated" discount, with the negotiation occurring between the hospital and a patient ombudsman before the patient ever arrives.)
- nicoburns 8y ago
  I wonder if you could even sell your own direct to consumers insurance. That would be one way to shake up the US healthcare market, but it need a hell of a lot of initial investment.
- pg_bot 8y ago
  I started a healthcare company and we set up the business so that patient tests, and procedures are not profit centers for the company. We make money off of a recurring subscription model, (direct primary care) and publish all of our prices upfront. We negotiate rates with local providers on your behalf and do not mark up their pricing. People need to stop expecting that their insurance should cover literally everything. Medical billing is usually around 40-50% of the total overhead for running a clinic. You can get rid of that entirely if you switch to a cash model.
  - derefr 8y ago
    > People need to stop expecting that their insurance should cover literally everything. Well, yes; in countries with public healthcare, there's still stuff that your coverage doesn't pay for (e.g. voluntary stuff like removing a mole.) But that uncovered stuff, in those other countries, still tends to be far less expensive than the equivalent service costs at even private "cash only" clinics in the US.
    - pg_bot 8y ago
      We tend to treat a lot of things as equivalent just because we have some statistic that we can use for comparison. I know it may sound shocking to some, but paying more does not necessarily mean that something is wrong. If I want a private hospital room, I want the services of a doctor that is in high demand, I want to use the latest technology, or I want something done faster and am willing to pay freely shouldn't I be able to? All of those things cost money, but are not accounted for when we are looking at the stats. You have to break things down into smaller pieces and figure out why things are more expensive before you can truly make an accurate comparison.
2trill2spill 8y ago
That's 100% the hospitals fault, no other profession would get away with not knowing how much the service they provided you costs and then making up a number to charge you.
- kazen44 8y ago
  how come the US is so opaque about pricing? Any other country i have been to (national insurance or not) has been absolutely transparent about pricing of healthcare. Including a GP in a tiny village in france who didn't speak english who sew back the skin on a finger after a nasty cut. (i had to pay a fee because i am not a french person, and the EHC doesn't cover "mundane" injuries like a deep cut in your finger.) the healthcare system in the US seems like total chaos to me.
  - vidanay 8y ago
    We aren't even transparent about the cost of buying a candy bar at the convenience store.
- refurb 8y ago
  Agreed! If you asked a Vision Correction clinic or cost metic surgery clinic the same question, I’m sure they could give you an exact answer. Simpler business model albeit.
rendall 8y ago
"Cost accounting. Hospitals are terrible at it." Which is the more reasonable explanation? A hospital does not tell a patient the cost of an x-ray upfront because: a) the hospital is terrible at accounting OR b) the hospital makes a higher profit by withholding or obscuring that information until after the procedure.
- wswope 8y ago
  I work in a hospital radiology department, and the main part of my job is cost accounting. Getting estimates of cost for medical procedures is surprisingly difficult and expensive. It takes many people many hours of work to figure out how much a specific set of procedures costs. Bureaucracy also makes the job far harder than it should be, but "moving fast and breaking things" can lead to people dying, so it's understandable why hospitals don't tend to be innovative enterprises. There is value in it, but at the same time hospitals don't have much incentive to lower costs. My job probably only exists because medicare/medicaid bundled payment schemes are finally forcing hospitals to look at costs. Basically, it's both A and B.

prostoalex 8y ago

> doctors and nurses worked and what they bill hourly Those guys are typically salaried, and that's likely one unknown. Another one is the legislatively imposed obligation that they provide [expensive] ER services to anyone who walks in regardless of insurance coverage requiring the hospital to potentially eat up the cost.

thaumasiotes 8y ago
Doctors are typically salaried; it was my impression (my mother is a doctor) that nurses are typically hourly. At least, she always quotes nurse rates as hourly.
amanaplanacanal 8y ago
I wonder how much those free ER services actually cost. It comes up in conversation, but is it 1% or 50%?