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Hospitals Must Now Post Prices. But It May Take a Brain Surgeon to Decipher Them
- freewilly1040 8y agoI wonder how they got the raw hospital price data, is it published anywhere?
- joecool1029 8y agoJust run a search for '<your local hospital name> chargemaster'. I found my hospital's price sheets in xlsx format easily. Just had a CT done a couple weeks ago for abdomenal pain, $750 without contrast according to the sheet (if I did not have insurance). I looked into costs for past procedures I had done in high school. I had kidney stones at 16. Lithotripsy was required which alone would have cost ~$65k according to the sheets. Tallying up the other minor stuff like meds and facility fees would have brought me close to $100k. Now you argue, 'well insurance pays less'. Of course they do. But I had experience in my mid-20's having to use hospital services without insurance. Rabies shots came to around $17k billed, I paid around $2k, and spent a year fighting to have my credit brought back to normal (hospital never applied a payment from a CDC program then reported me to collections).
- codegladiator 8y ago> Rabies shots came to around $17k billed, I paid around $2k Am I understanding something wrong or what ? Rabies vaccinations are something about $10 in India. I knew prices are up in US but this seems another level.
- ashelmire 8y agoYeah, this is real. Cheaper to fly to India if you don’t have insurance and need medical care.
- joecool1029 8y agoSo rabies vaccine should be dirt cheap. Like real cost is $10. I had immunoglobin, which is given if you have been exposed to rabies vector without being vacinnated beforehand. This is where the money is as it's made from modified human cells. I would guess this would still run a couple thousand even in India.
- shishy 8y agoIn case anyone was curious, there isn't a centralized list of everything yet. All the chargemasters are posted on the individual hospital websites.
- wjossey 8y agoI have a feeling some of these non-profits that are mentioned will take a crack at creating a centralized index. But, it sounds like it'll be a borderline impossibility to make it accurate and useful. To me, the argument that people can "shop around" for healthcare is just peculiar. For elective / non emergency scenarios, I get it. Dentists, for example, are more likely to face pricing pressure, given that dental work tends to be non-emergency. However emergency care, which is where insurance really matters, is by definition an emergency. If you cut off a finger, you don't call ten hospitals to find out who will stitch it on the cheapest. You head to the nearest hospital so you don't lose your finger! I'm generally quite sympathetic to Hayekian economics, but the model doesn't strike me as universal (which doesn't make it flawed, just not some grand unified theory). Behavioral economics change during time sensitive & life threatening situations in a way that "throw the rulebook out the window", so to speak.
- mises 8y agoFair point. But by the same token, the closer to an emergency good a procedure is, the less likely people are to buy it. To illustrate: I know someone who took off the top of her finger in a car door. She picked it up and drove to the nearest hospital. Database or no, the "cheapest ER near her" wouldn't have been an option. Admittedly, this is extremely, but it still communicates the point. Let's also not forget that cheaper often is correlated with a worse standard of care. The nearest ER happened to be a hospital with an expert hand surgeon on staff, and the hand of the lady in question looks nearly the same. The "cheapest ER near her" would likely have stitched up a stump. Functional, but inferior. Furthermore, the standard of care becomes much more important with anything life-threatening.
- dantheman 8y agoMost healthcare costs are not emergency care; its probably somewhere from 2% - 10% of healthcare costs: https://www.politifact.com/truth-o-meter/statements/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/ https://www.politifact.com/truth-o-meter/statements/2013/oct...
- DigitalSea 8y agoThis seems like a great opportunity for a company to invest serious time and money into creating a better-centralized database which will allow people to decipher and compare prices. It sounds like a highly-complicated task, but if someone can pull it off, that would be huge.
- wjossey 8y agoThe opportunity is likely more B2B than B2C, where insurers are more apt to negotiate down prices if they see they are "overpaying" based on comps. GoodRx already does this somewhat with prescription medication, by getting pricing data on prescriptions from local pharmacies. Perhaps, based on the GoodRx model, the opportunity is to improve price pressure on recurring procedures for patients who require ongoing dialysis treatment, dermatology care, physical therapy, etc. For emergency based care in hospitals, I still don't think it's a major net-win for consumers, as you don't care enough to ask about price when your leg is broken.
- keshwa01 8y agowho would you sell to - provider or payer? Payers should already be comparing across the providers they service. Providers would definitely find value - the challenge here is comparison based on list price are not inherently useful, yet obtaining negotiated prices would be difficult. I'm all ears for partnering if someone can get access to negotiated prices, even for a specific region.
- JumpCrisscross 8y ago> For emergency based care in hospitals, I still don't think it's a major net-win for consumers, as you don't care enough to ask about price when your leg is broken If I know in advance Hospital A is cheaper than and of the same quality as Hospital B, that could affect my decision around where to go for something like a broken bone. (Urgent, but not critical.)
- elyobo 8y agoAs a non American, based on what I've heard of the US system, I would absolutely ask about price for any medical treatment in the US if I was still physically capable of asking. Haven't broken a leg, so can't be sure whether I'd be functional - probably depends on how bad the break is :D
- leovander 8y agoThe data, posted online in spreadsheets for thousands of procedures, is incomprehensible and unusable by patients — a hodgepodge of numbers and technical medical terms, displayed in formats that vary from hospital to hospital. It is nearly impossible for consumers to compare prices for the same service at different hospitals because no two hospitals seem to describe services in the same way. Nor can consumers divine how much they will have to pay out of pocket. I took a look at the Vanderbilt charges[0] mentioned at the top of the article. If they could at least provide proper medical codes for procedures like they did in the drugs export, that would make it a lot easier to cross reference procedures/etc. between hospitals. You can look through my comment history on my complaints about it, but if these csv files or pdfs were generated with jasper reports or mirth connect (any other integration engine), its a shame that they missed out on either one extra column or one extra join to get all their corresponding codes in their exports. To the other comments' points, yeah someone could go ahead and start cross referencing codes, if they were all there, but the problem is that most systems are usually behind in code systems (e.g ICD9 vs ICD10) or they are made up using their own internal codes. You might end up with yet another set of standard codes that you would have to map to the official codes. Here are some value sets[1] that are listed on the HL7 site. If anyone did want to tackle this problem, start there to at least get a baseline in the types of labels/descriptions you will be seeing across the board. [0] https://finance.vumc.org/chargemaster/ https://finance.vumc.org/chargemaster/ [1] http://hl7.org/fhir/us/core/terminology.html http://hl7.org/fhir/us/core/terminology.html CPT - https://www.ama-assn.org/amaone/cpt-current-procedural-terminology https://www.ama-assn.org/amaone/cpt-current-procedural-termi... SNOMED - http://www.snomed.org/snomed-ct/get-snomed http://www.snomed.org/snomed-ct/get-snomed ICD-10 - https://www.icd10data.com/ https://www.icd10data.com/ RXNORM - https://www.nlm.nih.gov/research/umls/rxnorm/ https://www.nlm.nih.gov/research/umls/rxnorm/
- cinquemb 8y agoHaving had some experience with both SNOMED and RXNORM (for scraping and ETL for updates), you need login credentinals for both and I'm not sure how much they cost. Also they come in some large zip files (some are nested) so if you want to process it efficiently you should probably think about reading a particular file located inside, write to disk, process it, and deleting it and move on to the next without extracting it as whole.
- TheChaplain 8y agoThis is a great opportunity for startups who does price/cost aggregation and comparison.
- Nelkins 8y agoThis article strikes me as unnecessarily negative. This only began to roll out as of Jan 1, and the dust is still settling. Even if it's not perfect, it's still an improvement over the previous situation and I'm sure it will be iterated on.
- sam_goody 8y agoIt's a NY Times about something the Trump administration did. Relatively speaking, its surprisingly positive. There is a benefit to publicize the program and its shortcomings, so I am happy they wrote it up.
- sbr464 8y agoHere is the link to Vanderbilt's pricing [1] mentioned in the article. Has a few CSVs and PDFs, also Johns Hopkins[2]. Searching google generically for the term "chargemasters csv download" seemed to uncover a few more hospitals. Interestingly, I tried searching for "chargemaster" on Google Datasets search[3], and it only came back with one file. I think this shows the work needed to be done in this area (datasets search). [1] https://finance.vumc.org/chargemaster/ https://finance.vumc.org/chargemaster/ [2] https://www.hopkinsmedicine.org/patient_care/billing-insurance/billing/charges-fees.html https://www.hopkinsmedicine.org/patient_care/billing-insuran... [3] https://toolbox.google.com/datasetsearch/search?query=chargemaster&docid=05ZyhHyKdkjXc1p3AAAAAA%3D%3D https://toolbox.google.com/datasetsearch/search?query=charge...
- username3 8y agoPriceline for hospitals, when?
- onetimemanytime 8y agoHeart attacks, for one, don't wait for them to accept your offer. Also when you call 911 they decide where to take you. These lists are useless. God knows how many of those charges will they tack on your appendectomy, from unwrapping the syringe to administering the $4 pain killer. What we need is is a simple list like some surgery centers have. This operation will cost this much and includes everything.
- DennisP 8y agoMost hospital visits are for non-emergency care. Even for emergencies, I've put several people in ambulances over the last couple years and the drivers always asked which hospital we wanted. You're certainly right about needing total costs.
- sbr464 8y agoFound this github repo[1] about a proposed schema etc, and a wikipedia article about chargemasters[2]. [1] https://github.com/docgraph/Hospital_Charge_Master_Data_Schema https://github.com/docgraph/Hospital_Charge_Master_Data_Sche... [2] https://en.wikipedia.org/wiki/Chargemaster https://en.wikipedia.org/wiki/Chargemaster
- deleted 8y ago[deleted]
- dmitriid 8y agoI'm baffled that in comments people in all seriousness say things like "a great opportunity for a company to invest serious time and money into creating a better-centralized database" and "a great opportunity for startups who does price/cost aggregation and comparison". Are you serious?! It's not even like trying to cure the symptoms of a disease. It's like trying to treat a symptom of a symptom with essential oils.
- mac01021 8y agoWhat's the underlying disease? And, even if this isn't the path you'd like our healthcare system to take, isn't this new state of affairs a big opportunity for some startup?
- deleted 8y ago[deleted]
- droithomme 8y agoI've checked out the price lists from the hospitals in my area. They are useless. It's clearly a case of malicious compliance, and it seems to have been done universally and consistently across different markets, suggesting a criminal conspiracy to evade the law. Hospitals are already dangerous to go to since either the hospital is not covered by any given insurance plan, or the doctors at the hospital are not covered. It's pretty much impossible to get taken to a hospital that actually accepts your insurance and be treated by doctors who also accept your insurance. This has been bifurcated so precisely that it also indicates an intentional and designed conspiracy.
- rjtavares 8y ago> It's clearly a case of malicious compliance, and it seems to have been done universally and consistently across different markets, suggesting a criminal conspiracy to evade the law. Do you really believe this is a conspiracy instead of, you know, healthcare is complicated and the US market isn't working? Knowing something about hospital pricing, I looked at Johns Hopkins Hospital pricing and it looked perfectly legible. Item pricing in healthcare is pretty useless, that's just how it is.
- smileysteve 8y ago> Do you really believe this is a conspiracy instead of, you know, healthcare is complicated and the US market isn't working? Yes -- and I think it's pretty well documented. Though less conspiracy and more regulatory capture. Between several insurance companies - patients, doctors, and hospitals - , "not for profit" ever expanding and state sponsored hospitals, medicare, lost bills, medical debt, and somewhere in this, medicare and medicaid.
- rjtavares 8y agoHence the "US market isn't working" part. None of that is new and it all explains perfectly why the price listings are useless. Which is why suggesting a criminal conspiracy to evade the price listing law is ridiculous.
- deleted 8y ago
- AndyMcConachie 8y agoAmericans must think markets are like Gods. If we could previously say, "Kill 'em all and let God sort them out." Now we can say, "Starve them all and let markets sort them out." The only difference is in who we outsource our morality to. Either way we, as mere mortals, are not responsble for determining morality. Or quite literally in this case, who gets to live and who gets to die. The markets will fix it. Believe in the markets. They are our saviours and they are a fickle beast that we mere mortals cannot understand. Their actions are mysterious and their outcomes capricious, but we must believe because they are the one true God.
- conanbatt 8y agoMArkets are people. When you make your rhetoric on markets what you are actually raging against is the desire of human beings: that is what you despise.
- andyjsong 8y agoDon't hate the player, hate the game.
- salawat 8y agoThat's a copout if I've ever heard one. A few years ago, there was a game some adolescents would play where they would run up to an unsuspecting person person and bludgeon them as hard as possible to knock them out. There have been variants of the same pattern of behavior except involving strikes to other areas. It is absolutely justifiable to hate a person for engaging in a game that involves inflicting harm on others. This attitude to hate the game rather than those forcing it on everyone else just seeks to divest blame from the actors that perpetuate the malignant activity, to an assumption that "the game" is some mysterious standalone force that subverts the will of the participants and justifies their innocence. In short, "the devil made me do it" is not an excuse for poor moral choices. Lets take it even further. I have a game. I'm going to get all the lifesaving equipment I can, and open a facility. This facility is going to specialize in a particular type of highly asymmetric transactions, and I'm going to do everything I can to inflict the greatest financial harm I can, because gee, the way we keep score mandates I do so to keep the game going. It's a hard realization to come to, but as human beings and individuals, our collective behavior is dependent and a composition our individual choices. And for a not insignificant portion of our population, we have succeeded in allowing it to scrape together a world around itself where maybe it takes a week to explain the technicalities, but it doesn't take a layman more than an a 15 minutes to come to the conclusion there is something seriously wrong. This is one of those cases where rationalization has been left unchecked or unquestioned for far too long. To wrap around to the true meaning underlying your aphorism, which is diluted without context: Don't hate the market participants for participating in the market; but feel free to call out the hypocrisy of dealing in grievous financial harm in trade for necessary care. If you can't question or shame the actions of the ones perpetuating the status quo, you'll never change a blessed thing. Mrs. Bloom in Accounting is still a part of it. Even if she'd rather not think about it.
- sbr464 8y agoHere's all of the California data: https://oshpd.ca.gov/data-and-reports/cost-transparency/hospital-chargemasters/2018-chargemasters/ https://oshpd.ca.gov/data-and-reports/cost-transparency/hosp... https://data.chhs.ca.gov/dataset/hospital-annual-financial-disclosure-report-complete-data-set https://data.chhs.ca.gov/dataset/hospital-annual-financial-d...
- aboutruby 8y agoRead a random one, "Kaiser Foundation Hospital - San Francisco", Common25 is quite readable. but "CDM" is exactly as described in the article, it's basically an endless list of codenamed items. > Emergency Room Visit, Level 2 (low to moderate severity) $1,185.00 > Emergency Room Visit, Level 3 (moderate severity) $2,105.00 > Emergency Room Visit, Level 4 (high severity without signigicant threat) $3,263.00 > Emergency Room Visit, Level 4 (high severity with significant threat) $5,009.00 I guess that's the very minimum base price, quite offensive for an european like me.
- deleted 8y ago[deleted]
- tyfon 8y agoYes, here the emergency rooms are not allowed to even ask for name in case it will be a deterrent for an illegal immigrant to seek health care. Health care is a basic human right. We had an incident where a hospital here tried to charge an illegal for giving birth. It was an uproar in the news for weeks and the bill was dropped and hospital fined.
- assblaster 8y ago>Health care is a basic human right. How do you compel physicians to treat someone against their wishes? Threat of violence or other bodily harm? Genuinely curious how you Europeans enforce that "human right".
- cr1895 8y ago
- aub3bhat 8y agoSoon there will be Lemonade style app driven per hospitalization insurance on top of normal health insurance where for elective procedures you will be able to protect yourself from surprises like balance billing etc.
- mbrumlow 8y agoWhy do we always act like brain surgeons are any smarter than -- well any other type of surgeon? It seems to me it is mostly a dexterity thing. Much like a good butcher. Don't get me wrong. I am not trying to put down brain surgeons, I just think their job is less brain power and more physical performance.
- SiempreViernes 8y agoProbably people mixing up "power over brains" with "brain power".
- yason 8y agoNot necessarily smarter than... other scientists: https://www.youtube.com/watch?v=THNPmhBl-8I https://www.youtube.com/watch?v=THNPmhBl-8I
- coldtea 8y ago>It seems to me it is mostly a dexterity thing. Much like a good butcher. While it requires that too, being a brain surgeon is not about moving your hards delicately. Hopefully nobody goes to a "good butcher" for your their next brain surgery...
- mcv 8y agoI thought the notion of brain surgeon being synonymous with smart had died with Ben Carson's candidacy. His undeniable talent as a brain surgeon doesn't seem to translate very well to other areas.
- coldtea 8y agoNothing that a few convictions of hospital executives / accountants for fraud can't fix.
- matis140 8y agoSeem to remember insurance sets pricing somehow not the doc/hospital? One of the reasons they don't have an answer to that question is it depends on what your insurance carrier negotiated with the care network the doctor is probably loosely affiliated with because it was required by whoever now controls the administration in the builsing they currently work...except more complicated and less direct with lots more opportunities for people to pad the price another few % for each layer of abstraction because abstraction is always free.
- edoo 8y agoA step almost. The price charged to direct payers will not be the same price billed to anyone else, so fraud is still abound.
- yason 8y agoAny business that can afford to splice, destructure, and recompose their pricing into undecipherable mess is a strong sign they're doing too well, and have an unhealthy stronghold on their customers. If the markets are free enough I'd imagine some hospitals coming up with reasonable price lists that amortise the variance between successive operations and between the hospital and the patient. Most calls are routine anyway. Even car repair shops are able to quote rough price ranges even if they face a lot of unknowns. They will call you back if they find something else, and at least locally should the mechanic commit to a fixed offer he's only allowed to deviate from it by X percent. And routine jobs are generally advertised with fixed prices. The shops will undoubtedly swallow some of the accidental costs themselves to provide tighter quotes which is what customers like. Surely treating a human patient is more involved than that but the mechanism for pricing doesn't need to be. The hospital can calculate how much extra they need to add in the fixed prices to be able to "insure themselves" against the rare pathological case, to some extent. There's always the route of escalation from a routine operation to operating an acute trauma, but I can't imagine that would be common enough to explain the inability to provide reasonable quote ranges.
- viggity 8y ago"splice, destructure, and recompose" - this gives the impression that they're making complicated on purpose. In this regard you're giving them way, way too much credit. I can practically guarantee they're just dumping a report (or more likely a union of several reports). It is a giant bureaucracy that has had zero price pressure to force them to simplify. It is a function of 30 years of new inventions, complicated laws and IT as an afterthought. It akin to asking the IRS exactly how many taxable transactions exist. They have no effin' idea. They'll just push the 74,000 pages of the tax code at you and say "you figure it out"
- conanbatt 8y agoI agree. You do have players like Kaiser that show success on vertical integrations, but that is a slow business. The core key to achieve this is to separate insurance from the employer, and make health services truly compete with each other. Most people would probably end up with High deductible plans, and they will be very price sensitive to basic care costs.
- motohagiography 8y agoThese price lists look like "malicious compliance." Based on the quality of published data, one could rank hospitals in order of probable honesty. Crowd sourcing estimated bills based on price data vs. actual bills would provide another metric. If we in tech treated hospitals as being engaged in predatory wealth destruction, we could probably make a dent in the harm they cause. The most authoritative data could come from medical bill debts in collection, with signals in regard to how likely a given hospital is to make an egregious claim.
- FatDrunknStupid 8y agoOr maybe a Rocket Scientist - it's obviously not cool to be an accountant.