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> Modern Healthcare decided to see how long it would take to present the data in a more consumer-friendly format. It took less than two hours Having been throu

> Modern Healthcare decided to see how long it would take to present the data in a more consumer-friendly format. It took less than two hours Having been through several hundred thousand dollars of chargemaster charges with one of the hospitals on this list I can confidently say this info is not consumer-friendly at all. First of all, did anyone look at the damn PDFs? Do you have any idea what a "HCHG SP EVAL MTN FLUOR SWAL 75" is or a "HCHG XR RIBS BILAT W PA CXR"? Does this really equip the typical healthcare consumer with the ability to "shop 'n save"? No. They are going to ask their health insurance provider if the hospital is in network, and the health insurance bureaucracy has the experts who pour through and negotiate all this crap. Second, even if you had about a year of your life to educate yourself about the hundreds of myriad codes like this that are involved in various procedures and take it upon yourself to compare hospitals, this would be like comparing hotels based on their rack rate. You might get a sense for things but nobody pays that. Everything is negotiated down. Even for the uninsured who usually either get a 50%+ discount or pay whatever they can pay and kill their credit or go bankrupt. Which is not to imply in any way this is affordable for anyone, just that chargemasters aren't a super useful way to compare pricing even if you could figure it out. Third, it's a free market fantasy that more "consumer" info will fix this system. Many patients are not in a position to comparison shop anyway. It is the epitome of a market failure. If you want to fix this system we need Medicare For All.

joshgel 8y ago
I'm a doctor. I'm pretty sure I know what those things mean. But ya, wouldn't expect you to. Ultimately that's irrelevant, because you don't choose the services you get in a hospital, "I" do. If I come in and recommend this or that test, are you going to check the price? Of course not, because the issue is only partially hidden prices. Its also knowledge asymmetry and fear. I think most doctors only recommend tests they feel will be helpful and in my current position I have absolutely no incentive to order extra or unnecessary testing, so I try not to. I suspect (but I guess it hasn't been proven) that moving away from fee-for-service towards Medical Home type payments will resolve a lot of this as long as quality measures are carefully monitored and decreases in quality are appropriately sanctioned.
- beatgammit 8y ago
  I thought doctors had to be a but conservative due to lawsuit concerns and insurance requirements. I hear about concern over doctors misdiagnosing, so I'm guessing that doctors order more tests than strictly necessary to cover themselves.
- DanBC 8y ago
  > I think most doctors only recommend tests they feel will be helpful Why are the rates of over-testing and over-diagnosis so high?
  - Peradine 8y ago
    "helpful" may be defined as helpful in preventing the doctor from being sued
  - jrowley 8y ago
    > Why are the rates of over-testing and over-diagnosis so high? It is something health systems are aware of and working on, but if you go to the doctor with lower back pain and they say, get a better pair of shoes, take epsom salt baths, and deal with it, you might get frustrated. It doesn't cost the physician anything to order an MRI, but that procedure alone can costs $10k to your insurance, and may very well not reveal anything novel from the physical. But both the patient and physician feel more confident and there is no incentive against the physician for ordering the test. This particular example is such an issue, that a national quality measurement standards org has a measure dedicated to it: https://www.ncqa.org/hedis/measures/use-of-imaging-studies-for-low-back-pain/ https://www.ncqa.org/hedis/measures/use-of-imaging-studies-f... And now that we are monitoring it (at some cases, down to the physician level), we can see awareness grow and individual physicians are changing their ordering habits. Very cool.
zeroname 8y ago
Medicare for all would easily bankrupt hospitals. The money needs to come from somewhere. Either force people to buy insurance or raise taxes massively. Pick your poison.
- TylerE 8y ago
  Firing all of those billing specialists and insurance people would save a LOT of money.
  - zeroname 8y ago
    They are nevertheless a small part of the total bill.
    - abalone 8y ago
      Nope. They’re 8% of the bill, several times higher than countries with Medicare For All type systems.[1] [1] https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more-for-health-care-with-worse-population-health-outcomes/ https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more...
      - zeroname 8y ago
        That's total administrative cost. Given that (current) Medicare has high administrative costs as well, there's no reason to believe that the US will suddenly do much better with all its regulations. Either way, whether it is 2% or 8% the bill will be astronomical. You would have to cut health care worker's salaries significantly to make a big dent in it. I'm not saying that shouldn't happen, but you better own up to it.
- abalone 8y ago
  Literally every other industrialized country has a Medicare For All type system and somehow the hospitals manage to stay open. And you can’t mention a tax increase without mentioning the savings of not having to pay for private insurance.

joshgel 8y ago

I'm a doctor. I'm pretty sure I know what those things mean. But ya, wouldn't expect you to. Ultimately that's irrelevant, because you don't choose the services you get in a hospital, "I" do. If I come in and recommend this or that test, are you going to check the price? Of course not, because the issue is only partially hidden prices. Its also knowledge asymmetry and fear. I think most doctors only recommend tests they feel will be helpful and in my current position I have absolutely no incentive to order extra or unnecessary testing, so I try not to. I suspect (but I guess it hasn't been proven) that moving away from fee-for-service towards Medical Home type payments will resolve a lot of this as long as quality measures are carefully monitored and decreases in quality are appropriately sanctioned.

beatgammit 8y ago
I thought doctors had to be a but conservative due to lawsuit concerns and insurance requirements. I hear about concern over doctors misdiagnosing, so I'm guessing that doctors order more tests than strictly necessary to cover themselves.
DanBC 8y ago
> I think most doctors only recommend tests they feel will be helpful Why are the rates of over-testing and over-diagnosis so high?
- Peradine 8y ago
  "helpful" may be defined as helpful in preventing the doctor from being sued
- jrowley 8y ago
  > Why are the rates of over-testing and over-diagnosis so high? It is something health systems are aware of and working on, but if you go to the doctor with lower back pain and they say, get a better pair of shoes, take epsom salt baths, and deal with it, you might get frustrated. It doesn't cost the physician anything to order an MRI, but that procedure alone can costs $10k to your insurance, and may very well not reveal anything novel from the physical. But both the patient and physician feel more confident and there is no incentive against the physician for ordering the test. This particular example is such an issue, that a national quality measurement standards org has a measure dedicated to it: https://www.ncqa.org/hedis/measures/use-of-imaging-studies-for-low-back-pain/ https://www.ncqa.org/hedis/measures/use-of-imaging-studies-f... And now that we are monitoring it (at some cases, down to the physician level), we can see awareness grow and individual physicians are changing their ordering habits. Very cool.

zeroname 8y ago

Medicare for all would easily bankrupt hospitals. The money needs to come from somewhere. Either force people to buy insurance or raise taxes massively. Pick your poison.

TylerE 8y ago
Firing all of those billing specialists and insurance people would save a LOT of money.
- zeroname 8y ago
  They are nevertheless a small part of the total bill.
  - abalone 8y ago
    Nope. They’re 8% of the bill, several times higher than countries with Medicare For All type systems.[1] [1] https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more-for-health-care-with-worse-population-health-outcomes/ https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more...
    - zeroname 8y ago
      That's total administrative cost. Given that (current) Medicare has high administrative costs as well, there's no reason to believe that the US will suddenly do much better with all its regulations. Either way, whether it is 2% or 8% the bill will be astronomical. You would have to cut health care worker's salaries significantly to make a big dent in it. I'm not saying that shouldn't happen, but you better own up to it.
abalone 8y ago
Literally every other industrialized country has a Medicare For All type system and somehow the hospitals manage to stay open. And you can’t mention a tax increase without mentioning the savings of not having to pay for private insurance.