10 ms·
Trump proposes forcing hospitals to disclose discount rates with insurers
- sneak 7y agoI am pretty sure that not disclosing these figures makes the hospitals far more than $300/day (the proposed fine for noncompliance with the disclosure rule).
- BonesJustice 7y agoIndeed. Raise the cap to $300,000/day per facility, and this might actually have an effect. For most hospitals, a fine of $300 a day isn’t a fine at all, and I assume that’s by design.
- tropo 7y agoWhose design? My guess is that the agency can't go higher due to an outdated law from when the agency was founded. Lots of laws have fixed dollar amounts which eventually get absurd due to inflation. From CNBC: "The public comment period will be open until the end of September. If finalized, the rule would take effect in January." So, leave a comment. Ask for something large, tied to inflation or to hospital revenue.
- Consultant32452 7y ago$300 per customer per day would work. Or $300 per service line item per customer per day. Preferably paid to the customers.
- tropo 7y agoThis is wonderful, and so the medical industry would fight it with all their might, except for one problem: the fine is only $300 a day. That is about the cost of a nurse. It'll matter for little urgent care shops staffed by a handful of people. City hospitals will laugh at $109,572 per year. Well, it's a step in the right direction.
- Ididntdothis 7y agoI don’t know if this is a step in the right direction. It sounds more like they want the PR value of “doing something” without actually doing anything useful. This seems to be the case with almost all initiatives in the health care area for the last few years.
- credit_guy 7y agoWhile $300/day is indeed ridiculously little, these fines would be published on a website, as per the factsheet [1] "If the hospital fails to respond to CMS’ request to submit a corrective action plan or comply with the requirements of a corrective action plan, CMS may impose a civil monetary penalty on the hospital not in excess of $300 per day, and publicize these penalties on a CMS website." I guess a "name and shame" strategy could lead to increased public awareness, and later to political pressure, which in time would translate into political action. At least that's how democracy is supposed to work. Separately, the public is asked for feedback on the proposed rule until 27-Sept-2019. Not sure how this works, but I guess a grassroots movement could result in an increase in this diminutive fine. [1]https://www.cms.gov/newsroom/fact-sheets/cy-2020-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center https://www.cms.gov/newsroom/fact-sheets/cy-2020-medicare-ho...
- mars4rp 7y agoyou need name and shame if you are a civil activist not when you are government!!!!!
- b_tterc_p 7y agoWhile it may be economical to pay the fines, I don’t think many hospitals would choose to tank the fine and keep hiding the information. That’s some pretty bad PR when it adds up. A larger fine would be better, but I think this will be sufficient.
- Ididntdothis 7y agoTheir billing practices are already getting a lot of PR and nothing has changed. They can easily handle this too. Especially since probably close to nobody will know about this list.
- pkaye 7y agoI don't how much that will accomplish. Lots of people without insurance have no means to even pay the discounted rates. I had a drug that until it was available in generic form was $90 (so at 10% copay, I presume it cost the pharmacy $900) But lets say that was a lie and it actually cost $200. Without insurance it would still be too expensive to many people.
- larkost 7y agoI agree that this would not enable people to suddenly be able to afford medical services that they otherwise would not, but I do see some advantages to the system in general: 1. For people without insurance it would possibly give them a little more bargaining power in the negotiations around bills. Right now the hospital holds all the cards, especially when it comes to "costs". 2. It would shine a little light into an area that is generically murky. A lot of people are champions of capitalism/markets being the solution for all/most problems, but market systems do not work well at all when there is a heavy information imbalance. Pretty much every theory of capitalism talks about that. Right now an enormous information imbalance pretty much sums up the U.S. healthcare system.
- pkaye 7y agoAre hospitals really that profitable? Take SF general hospital for example. Its obligated to take care of the homeless, drug addicts, under insured that they seem to overcharge the few insured that get admitted to balance their budgets. I'd be curious for an actual fair accounting of things. Are they really flush with money and just overcharging?
- masonic 7y agoPublic hospitals don't operate on a profit model. If you go down the street, however: https://www.vox.com/2019/1/22/18183534/zuckerberg-san-francisco-general-hospital-er-prices https://www.vox.com/2019/1/22/18183534/zuckerberg-san-franci...
- hk2001 7y agoWhat actually often happens is that drugs priced at $90 get marked up to $200 with the knowledge that insurers will get a $90 price. The rebate system paradoxically creates an incentive system where it is insurers best interests for list prices to increase dramatically and then receive a discount than for the products to be sold at the discounted price in the first place. It’s a broken system and replacing it should help medicines be priced closer to what real people can pay for.
- txru 7y ago"When a measure becomes a target, it ceases to be a good measure" [0] [0] https://en.wikipedia.org/wiki/Goodhart%27s_law https://en.wikipedia.org/wiki/Goodhart%27s_law
- ars 7y agoIt's not a measure though, lower prices are the target. That law only applies when the ultimate desired goal is different from the target. When the target is the goal then using it as a measure works perfectly.
- resters 7y agoThis would improve the negotiating position of some parties and harm that of others, but only slightly if at all. Most likely it will make hospitals less likely to allow any single price to be negotiated too low. Consider that when negotiating a basket of goods, the buyer and seller may agree on a low price for item A and a high price for item B based on their own preferences, but this does not mean that they cared specifically about item A or B since the negotiation was over the basket. We see this all the time whenever products and services are bundled. The negotiation may result in some prices being lowered, but overall the seller has a lot of knobs to adjust to make the buyer happy. So all this will do is modify the negotiation slightly and possibly provoke some sensational headlines in the near term.
- ma2rten 7y agoIt would create transparency. Over the long-term that means that prices will become more equal. The people who are paying the most (un-/underinsured) will be the ones who benefit the most.
- mc32 7y agoI think you’re right. I recall hearing about an exemplary case s few years back before ACA, Some guy was shopping around for, I think it was, hip surgery. It was opaque and took some effort but finally settled on some place in the south, possibly AL. It ended up being like a fifth of what his state’s hospitals would do if for. So, the short is, yes, transparency would help.
- wbl 7y agoEqual but higher. Hospitals will be able to tacitly coordinate on prices once they are all public.
- t-writescode 7y agoPrice-fixing is illegal.
- 7y ago
- b_tterc_p 7y agoIs there any reason not to make discounted rates for insurers illegal?
- octorian 7y agoYeah, if discounted rates were illegal, then some of the more simplified Republican arguments against requiring and/or subsidizing health insurance might actually make sense. This whole system of discounted rates is why you're pretty much forced to have insurance as a "payment intermediary," even for stuff that you'd otherwise think paying out of pocket would be reasonable for.
- maerF0x0 7y ago> some of the more simplified Republican arguments against requiring and/or subsidizing health insurance might actually make sense. Which arguments are those?
- pingpongchef 7y agoWhat reasons are there to make them illegal?
- Retric 7y agoCost shifting in healthcare is zero sum at significant economic cost. Aka, the net result of these negotiations is higher healthcare costs even if they can benefit the participants. On the other hand healthcare providers competing on an open market with transparent pricing would presumably actually reduce costs.
- asark 7y agoIt'd effectively make insurers (and everyone else who pays for healthcare) one big negotiating block. The weakest payer gets the benefits of scale of the largest. One might hope that would push prices down. (for the record I personally just want the simplest thing that's very likely to work—single payer—rather than any complicated poke-the-market-and-pray solutions, but I think that's the idea of such a measure)
- mgamache 7y agoAt worst it will have no impact. But even if consumers can't negotiate the discounted price themselves they know the premium they are paying for their current plan. Right? This might encourage a single payer system (for good or bad).
- conductr 7y agoWe need to stop focusing on single payor system as it’s too political. Something everyone can get behind is a single price system. The government has the ability to do that without becoming our insurance administrators. At the least, healthcare companies could reduce a huge amount of labor tied up in billing and insurance could do the same for labor tied up in fighting claims
- hkai 7y agoWould you say setting a single government-mandated price for goods, services or currencies has worked very well in the past?
- conductr 7y agoSo, this is a simple idea not fully thought out. But you’re point is hollow. Democracy has failed many places, do we give up our way of government? In the context of healthcare, using the current Medicare system as a proxy. Yes, it mostly works. CMS sets prices, generally based on what things should cost with a reasonable margin, and in general Medicare patients are receiving quality care. Beyond that I don’t have much knowledge. I’m sure you’re referencing some examples of fixed corn prices and how it resulted in shortages or something like that. Which may be valid. However, I think you could get creative and build some pricing models that were much more effective than a fixed price. Or, the minimum government involved way, would be to simply mandate that payors of all types are billed and pay the same amount for same services. Then the market is responsible for compliance. Either way, the way to get ahold of healthcare is on price. The only reason Medicare for all has any legs is because Medicare is known for controlling price. But the downside is government becoming the administrator. I’m just saying there’s other ways to focus on price and the government could help through legislation.
- themagician 7y agoThis is a good first step. The second step being setting caps on what health care providers can charge to those who are uninsured, or for which a particular insurer won't cover. Instead of some ridiculous number that no one actually pays, they should only be able to charge the uninsured a maximum which is the average of what they actually receive. If they receive, on average, $850 for an MRI then that should be the most they are legally allowed to charge someone who is uninsured. Clearly it's still profitable for them to do so at this price point, and it doesn't bankrupt the individual.
- awinter-py 7y agoprice transparency critical for markets. however we get this done, let's do it. surgeon scorecards while we're at it.
- OnlineCourage 7y ago> surgeon scorecards while we're at it. Yelp reviews for cardiologists, I can see it now: "Well, I'm still alive, so that's a plus, but he told me very rudly to cut down on salt! One star!"
- red-indian 7y agoI had to go to the corporate owned emergency room recently. They told me that as an uninsured person my discount was 70%. They wouldn't tell me what the insured discount was even though I asked. For 5 minutes with the doctor and there's nothing we can do today follow up with you GP doctor tomorrow or ASAP, the bill was only $145.50, discounted from $485. The follow up with my doctor during weekday hours was $70.
- woofyman 7y agoI was badly bitten by a dog. The ambulance took me to a trauma center that was out-of-network. The retail cost of my 6 hour stay was $11,800. This didn’t include the ER doctor and radiologist. My insurance covered only $2800 of the $11,800 (what they considered reasonable). I have a $7900 deductible. Since they were out-of-network, the hospital could have billed me for the entire amount (balance billing). Happily they reduced the charge to $1000.00
- conductr 7y agoI once paid $1000 because my wife had to basically go to the ER for an antibiotic prescription. You know, when you already know you have a upper respiratory infection, but you required to see the doctor. They wouldn’t negotiate with me. So don’t rely on this in the future.
- jilles 7y agoAs someone who moved to the US from the Netherlands, this scares me.
- colbyh 7y agoOne of my favorite things about the US insurance market is that the lack of transparency into pricing actually hurts both the insured and the institutions providing care. Small and medium size practices have very few guarantees about how much they will get reimbursed for a procedure and the patient has no idea how much they will pay. It's truly insane. Is anyone honestly trying to solve those problems right now?
- whydoineedthis 7y agoHrmm...not sure most of what you said is true. Small and medium business may lose claims, but they know the reimbursement for each procedure and if thier claims are legit, they will get reimbursed. There's a requirement to share how much a consumer needs to pay before procedures are done also. Unless your talking about ER care specifically, that's a different beast where you are somewhat correct.
- red-indian 7y ago"they know the reimbursement for each procedure" This is not true. "There's a requirement to share how much a consumer needs to pay before procedures are done" This is not true.
- buzzerbetrayed 7y agoSounds like it is your word against his. Do either of you have any sources?
- colbyh 7y agoI work in the industry. Fee schedules are an upper bound, but the lower bound is very hard to get numbers on and often approaches 0. If I go in for a procedure at a medium sized specialist clinic they are going to take the fee schedule for this CPT, discount by my 20% expected contribution (or whatever), and then hope that the insurer pays them > 50% of the remainder. A lot of the time my insurer will, but not always. Bigger systems negotiate their own fees and many doctors at larger clinics only track RVUs for each procedure (specifically because the clinics realize that paying based on insurance payout isn't fair or scalable, in that way RVU allocations act as a pool). But overall it's not a transparent system for the majority of people working within in.
- mnm1 7y agoOoh a whole $300 a day. Scary. That's $110k a year roughly. Pocket change for either the hospital or the insurance companies should they wish to not disclose these prices. That's if they even survive a court challenge and if the drug price disclosure is anything to go by, they won't. This is just bullshit the current administration is pushing to pretend like they are doing something positive for healthcare when all they want is to take people's healthcare away and let them die so that money can be used to line the pockets of insurance and other companies.
- RickJWagner 7y agoSeems like a good move. It's hard to imagine how transparency can do harm.
- tzs 7y agoI don't see how it could directly cause harm...but I'm also having trouble seeing how it will help, and if it doesn't help it may cause indirect harm. The indirect harm would be that by spending effort on something ineffective it may make it harder to do things that would be effective, by taking some of the heat off politicians on the health care cost issue.
- tzs 7y agoI don't know if the WSJ article mentioned this, because I cannot read it, but according the the NYT article on this [1] when asked where the legal authority to force such disclose comes from the administration cites an ACA provision that requires hospitals to make a public list of standard charges. But this same administration is currently arguing in Federal court that the entire ACA is invalid, which means that they are also arguing that this new proposal has no legal basis. [1] https://www.nytimes.com/2019/07/29/health/hospital-rates-insurers-trump.html https://www.nytimes.com/2019/07/29/health/hospital-rates-ins...
- CSactuary 7y agoFixing the US healthcare system really is not that hard. Just low incentive for the upper crust with plans that subsidize 90%+ of their healthcare through their companies/employers. How to fix it: 1. Single payer - hard to maintain equality without it, insurers are not incentivized to lower healthcare trend due to max MLR rules 2. High OOP plans for all - force consumerism, sliding scale of ded/oopm based on income so poor are inherently subsidized more than rich 3. Easier path to becoming MD - more docs, more competition 4. Higher standards for maintaining license to practice medicine - more pressure to provide high quality care 5. Transparent prices - ability to shop for healthcare like any other good, prices will naturally hit an equilibrium due to consumerism and increased competition 6. Add a steerage layer to the system for all - call med-help line or go to web/app for care - type in symptoms, it gives you options with distance/prices etc to allow people to make more informed/economical decisions 7. Better Interoperability in EHRs - easily share medical records with a new provider, reduce duplicative care and waste Just these items would help bring trend back in line with CPI. I like this solution because everyone gives a little - providers and consumers and the insurers and brokers give a lot (but eliminating their costs alone would be a boon). The biggest risk would be the ability of a public entity to implement and enforce such a system and to keep incentives high for providers and researchers
- semerda 7y agoA small step but a good one towards price transparency. What industry apart from healthcare do you know where you first get service and then find out the price of it. lol The sad part about all this is that the level of healthcare pricing transparency we all need/want must come down from the top. Are there any startups looking at this problem?
- hkai 7y agoI feel that Trump's administration has not considered the ways this will hurt poorer people and especially minorities. Or maybe they did, and went ahead anyway.