4 ms·

NewYork-Presbyterian Hospital Price List

45 points by SQL2219 6y ago

talos 6y ago
Interesting to see this data released, but I'm a little dubious. According to the spreadsheet, Aetna is always paying 100% of list, and SEIU 1199 is always paying exactly 50%. Most of the other private providers are listed with almost-flat discounts (85% for CHP, 71% for Empire, 60% for Healthfirst) with a handful of operations at other price points. Cigna has a little more variety but is mostly listed at 51%. Only Emblem shows real variety across the board, with prices listed from 21.9% to 174%. It also has the lowest mean/median, at 45% and 34% respectively. I know from personal experience that Aetna does have negotiated rates with NYP, and the flat discounts for all providers other than Emblem are also suspicious.
nojito 6y ago
People are getting way too excited about this. The real costs we are missing is the prices insurers pay for procedures by billing code and provider.
- spaetzleesser 6y ago
  I thought the latest executive order requires them to publish the negotiated prices. Is that not the case? In the end I think they should have to publish the actually paid prices at the end of the year.
- jaboutboul 6y ago
  Yes but it’s a first step.
  - robin_reala 6y ago
    …in the wrong direction. Rather than validating the concept of paying for individual operations, the humane thing to do would be to smash the system entirely.
    - yoshiama12 6y ago
      Actually if you want fair pricing for a unified system you need radical reconsideration of pricing and transparency. Even if you are alluding to single payer...you don't want them to practice over the top pricing that is inefficient to our government :p
- tssva 6y ago
  The spreadsheet provided at the link includes exactly that information.
  - nojito 6y ago
    Nope it's only what hospitals charge to different insurers. That's different from what insurers pay out by procedure to providers. Common misconception.
    - tssva 6y ago
      You have made this comment twice and I'm not sure I understand from it what you are looking for that is different from the information provided. The only thing I can think of is you are looking for the split of the negotiated amount paid by the insurer vs the patient. This of course can vary based upon the particular level of coverage the patient has with the insurer.
- sgron 6y ago
  If you would have opened it, you would have seen that the spreadsheet has exactly what you're asking for... reimbursement rates by DRG/CPT code and insurer. You're right that in many cases the rates paid by different insurers vary significantly.
  - nojito 6y ago
    No it doesn't. That's the charges hospitals charge for patients under those plans What I am asking for is completely different. I want to know what insurers pay out by procedure code by provider. There's a reason why insurers lobbied against providing this information under this law.
tnuc 6y ago
These prices are fairy tales. It's a figure next to no one will actually ever pay. Insurers pay less. If you ask for a discount you will pay less.
- tssva 6y ago
  Negotiated prices with insurers is included in the provided list.
- eganist 6y ago
  > These prices are fairy tales. It's a figure next to no one will actually ever pay. Insurers pay less. If you ask for a discount you will pay less. Columns H through AI represent the negotiated insurance rates or agreed schedules. AJ represents the lowest negotiated charge for that service across all providers. Interesting reading, really. Aetna largely seems to pay retail, whereas others like Cigna and Emblem are getting "decent" discounts. Also provides a good basis for negotiation if you're a cash payer. "I can pay your minimum negotiated charge for this, or I can dispute it during collection" But even still, these prices are ridiculous even after negotiation and are indicative of a broken system. For what it's worth, hospitals aren't charging these fees because they're profiting; many of them are struggling to stay in the black. (I used to run appsec at a healthcare best practice and advisory firm. A lot of my background on this was absorbed through osmosis, though I can't say I'm an expert)
f6v 6y ago
> List of Shoppable Services > Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc These aren’t shoppable services...
- eganist 6y ago
  Well, the latter might not be as shoppable (you know, because it's time sensitive), but joint replacements certainly can be.
chris_f 6y ago
The file says "Confidential Proprietary Information" just above the price list. What does that mean in this context? They are making it publically available on their website, and one of the intents of the new bill was to make this information machine readable so developers could build upon it.
- eganist 6y ago
  In all honesty, it's probably a line they forgot to remove. This document looks like it's in response to new executive action around price transparency.
huitzitziltzin 6y ago
These files are more widely available than people think. For California for example, an agency called OSHPD makes available a set of documents called “charge masters” which have similar information. This appears to be a little different bc it looks like they are listing an insurer-specific (e.g., an Aetna negotiated price). That would be very very unusual. However the caveat on the linked page suggests that maybe that data isn’t what it appears to be. Regardless, this kind of price transparency (even if the negotiated prices are available) is not obviously something which is going to bring prices down.

45 points by SQL2219 6y ago

Interesting to see this data released, but I'm a little dubious. According to the spreadsheet, Aetna is always paying 100% of list, and SEIU 1199 is always paying exactly 50%. Most of the other private providers are listed with almost-flat discounts (85% for CHP, 71% for Empire, 60% for Healthfirst) with a handful of operations at other price points. Cigna has a little more variety but is mostly listed at 51%. Only Emblem shows real variety across the board, with prices listed from 21.9% to 174%. It also has the lowest mean/median, at 45% and 34% respectively. I know from personal experience that Aetna does have negotiated rates with NYP, and the flat discounts for all providers other than Emblem are also suspicious.

nojito 6y ago

People are getting way too excited about this. The real costs we are missing is the prices insurers pay for procedures by billing code and provider.

spaetzleesser 6y ago
I thought the latest executive order requires them to publish the negotiated prices. Is that not the case? In the end I think they should have to publish the actually paid prices at the end of the year.
jaboutboul 6y ago
Yes but it’s a first step.
- robin_reala 6y ago
  …in the wrong direction. Rather than validating the concept of paying for individual operations, the humane thing to do would be to smash the system entirely.
  - yoshiama12 6y ago
    Actually if you want fair pricing for a unified system you need radical reconsideration of pricing and transparency. Even if you are alluding to single payer...you don't want them to practice over the top pricing that is inefficient to our government :p
tssva 6y ago
The spreadsheet provided at the link includes exactly that information.
- nojito 6y ago
  Nope it's only what hospitals charge to different insurers. That's different from what insurers pay out by procedure to providers. Common misconception.
  - tssva 6y ago
    You have made this comment twice and I'm not sure I understand from it what you are looking for that is different from the information provided. The only thing I can think of is you are looking for the split of the negotiated amount paid by the insurer vs the patient. This of course can vary based upon the particular level of coverage the patient has with the insurer.
sgron 6y ago
If you would have opened it, you would have seen that the spreadsheet has exactly what you're asking for... reimbursement rates by DRG/CPT code and insurer. You're right that in many cases the rates paid by different insurers vary significantly.
- nojito 6y ago
  No it doesn't. That's the charges hospitals charge for patients under those plans What I am asking for is completely different. I want to know what insurers pay out by procedure code by provider. There's a reason why insurers lobbied against providing this information under this law.

tnuc 6y ago

These prices are fairy tales. It's a figure next to no one will actually ever pay. Insurers pay less. If you ask for a discount you will pay less.

tssva 6y ago
Negotiated prices with insurers is included in the provided list.
eganist 6y ago
> These prices are fairy tales. It's a figure next to no one will actually ever pay. Insurers pay less. If you ask for a discount you will pay less. Columns H through AI represent the negotiated insurance rates or agreed schedules. AJ represents the lowest negotiated charge for that service across all providers. Interesting reading, really. Aetna largely seems to pay retail, whereas others like Cigna and Emblem are getting "decent" discounts. Also provides a good basis for negotiation if you're a cash payer. "I can pay your minimum negotiated charge for this, or I can dispute it during collection" But even still, these prices are ridiculous even after negotiation and are indicative of a broken system. For what it's worth, hospitals aren't charging these fees because they're profiting; many of them are struggling to stay in the black. (I used to run appsec at a healthcare best practice and advisory firm. A lot of my background on this was absorbed through osmosis, though I can't say I'm an expert)

f6v 6y ago

> List of Shoppable Services > Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc These aren’t shoppable services...

eganist 6y ago
Well, the latter might not be as shoppable (you know, because it's time sensitive), but joint replacements certainly can be.

chris_f 6y ago

The file says "Confidential Proprietary Information" just above the price list. What does that mean in this context? They are making it publically available on their website, and one of the intents of the new bill was to make this information machine readable so developers could build upon it.

eganist 6y ago
In all honesty, it's probably a line they forgot to remove. This document looks like it's in response to new executive action around price transparency.

huitzitziltzin 6y ago

These files are more widely available than people think. For California for example, an agency called OSHPD makes available a set of documents called “charge masters” which have similar information. This appears to be a little different bc it looks like they are listing an insurer-specific (e.g., an Aetna negotiated price). That would be very very unusual. However the caveat on the linked page suggests that maybe that data isn’t what it appears to be. Regardless, this kind of price transparency (even if the negotiated prices are available) is not obviously something which is going to bring prices down.