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It would be nice to be able to see the lowest & highest prices & other stats. I can manually find the lowest price by sorting by price but I can't seem to rever

It would be nice to be able to see the lowest & highest prices & other stats. I can manually find the lowest price by sorting by price but I can't seem to reverse it to show the highest price first... Anyway, it seems that there are orders of magnitude differences for the same service. The service 'MRI Lumbar Spine With & Without Contrast Material' has a lowest price of $210 while the closest and highest I personally could find was ~$4109. How can there be such a large difference in price for something that, I believe, is legally & medically the same procedure?

nugget 6y ago
In 2015 I did several months of due diligence in this market - price comparison for diagnostic imaging - before concluding that it wasn't feasible to build the product we wanted to build. This new law provides the data that we were unable to access (at scale) on our own. From the data we did get our hands on, I remember seeing price differences like $200 vs $4k for the exact same procedure. The low cost provider was usually a private practice radiologist in a small shopping mall type retail location who ran a very efficient, low overhead practice. They were terrible at marketing and ran discounts for volume from certain channels. They were only open Monday to Friday from 8am to 4pm, read times could often (but not always) be slow, they handled the least complex cases and no emergencies. Cash pay up front from patients resulting in no/minimal collections. The high cost provider was usually a large University affiliated medical center who ran a less efficient, high overhead radiology department but who also, in their defense, had to handle more complex cases as well as be open 24/7 to service one or multiple emergency departments with faster read times. Lots of fighting with insurance companies for eventual reimbursement. Lots of bad debt that went to collections and had to be written down. If you pay University prices for a simple MRI you are effectively subsidizing the ED admit who needs a complex imaging procedure in the middle of the night. If consumers start to shop for MRIs the way they shop for airline tickets - which they probably should - one downstream effect will be to remove billions of dollars of "subsidies" from the most well-resourced radiology departments in the country. If I remember correctly the diagnostic imaging market was something like $150 billion/year in 2015, and probably even bigger now, i.e. plenty of potential fat to cut.
- kfarr 6y ago
  Response time / availability is not something I considered in medical service pricing before but wow it makes a lot of sense.
- wjossey 6y ago
  For folks who don’t believe in universal medical coverage, this is part of the reason why it’s so inefficient for it not to exist. The uninsured person going to the hospital at 1AM that requires an MRI because slipped a disc in their back still ends up getting that MRI. When they fail to pay that bill, which would be 5%-10% of their annual earnings, we all still pay for it. We just decided to layer in debt collection, anxiety, and depression onto the patient in lieu of cash. As someone who still considers themselves a fiscal conservative, and also believes we need true universal coverage for all Americans, this seems like a no brainer to me at this point (and I say that as someone who would have not supported this in the 00s but has evolved significantly on this issue).
  - nugget 6y ago
    My takeaway from all that research was the same. Almost everyone benefits from universal coverage but the system has to incentivize patients to shop around for the optimal balance of price, quality, and convenience. This can be accomplished with an annual deductible of a few thousand dollars perhaps capped at a % of income. Without this incentive, costs skyrocket. Price transparency is a pre-requisite without which consumers can't easily shop around, so this law is a giant leap forward in the right direction. That is the #1 most effective thing that Americans can do to reduce health care costs. #2 would be to change the standard American diet and eat healthier to reduce rates of obesity and diabetes. Almost every other proposed structural change or intervention we looked at was minimal by comparison.
    - zaphod12 6y ago
      There was an attempt at this with prescription drugs. Encourage patients to take generics by forcing a larger amount of cost onto the patients in the form of higher copays. Pharma companies realized and started giving copay vouchers (still charge insurance more, but short circuit the patient incentive). When that loophole got tighter they formed charitable foundations to give the vouchers instead. I'm not disagreeing with your points, per se. It's just amazing what entrenched interests can manage.
subhro 6y ago
> How can there be such a large difference in price for something that, I believe, is legally & medically the same procedure? I hope this never happens, but let’s say you got in a motorcycle accident and need that lumbar MRI to figure out the damage. What are going to do, get back on that wrecked motorcycle with a fucked up spine and go to that 210$ place? They do it because they can do it and get away with it.
- eldavido 6y ago
  I see this argument a lot. The trouble is that emergency care isn't what drives the majority of healthcare spend. What does is actually chronic conditions: dialysis, diabetes, autoimmune disorders, chronic weight conditions. That's what we need to worry about. And if there was a real market here, you wouldn't need to shop around because all the people that do, would enforce some level of price discipline on the market. Think about it. For any good sold at, say, Wal-Mart, say Gatorade, there are some people that want it a LOT, even NEED it, while others are more on the fence. There's only one price on the shelf and it's calculated to get a lot of people buying. So in effect, the people who are more indifferent (want it less) are actually doing a pretty significant service to the people who want it a lot, by guaranteeing the price will be set low for everyone. There's no reason something like this can't apply in healthcare.
LatteLazy 6y ago
>How can there be such a large difference in price for something that, I believe, is legally & medically the same procedure? If no one publishes their prices how do you set yours? 2 dollars? 2000 dollars? 2m dollars?
- spaetzleesser 6y ago
  I am pretty sure the providers and insurers know exactly what everyone is charging. It’s the patients that are being kept in the dark.
  - deleted 6y ago
    [deleted]
  - LatteLazy 6y ago
    Like any opaque market, bigger players will have more info, but I doubt anyone will share information as its collusion (maybe illegal) and also advantages either your negotiating opponent or your competitors...
    - mrnickel001 6y ago
      Exactly. Small payers are actually pretty hungry for this data. Generally, big payers are more privy to market rates (by paying for datasets, owning clearinghouses, etc).
  - sib 6y ago
    When I needed a similar non-emergency procedure (cervical, rather than lumbar, MRI), my neurosurgeon, at a large, university-affiliated hospital, referred me to the in-house radiology department. Within a day or two, I received a phone call from some department at my health insurance provider telling me "Hey, we see that you are going to get an MRI; did you know that you can get the exact same procedure at providers A, B, and C, for a lot lower cost?" They did this even though the hospital's radiology department was in-network. In this case, the cost difference was similar to what's noted here - about $4,000 vs $450. Since the insurance company was paying most of it, aside from my copay / share of cost, they were motivated to provide me a little transparency. To be honest, as a patient, I would have preferred to get the MRI at the hospital; their facility was nicer, cleaner, more modern, and there was better data integration for getting the results to my neurosurgeon and keeping them as part of my holistic medical record. Nonetheless, I went to the cheaper provider.
mrnickel001 6y ago
Thanks for the feedback! We'll be improving our filter/sort here in the coming days and we'll take this feedback into our plan.
- ilaksh 6y ago
  My searches so far show insane differences between insurance rates and cash rates. The cash can be 5-10x higher than what the insurance company pays. It seems like a clear case of systemic fraud to me. Am I missing something? Also I am not able to find any fundoplication or LINX (43284).
  - mrnickel001 6y ago
    Many hospitals don't discount from their list price for self pay. Medicare pays ~10% of list price. So, for example, if there is an insurance rate set at "130% medicare" (common to have a coefficient between 1 and 2), then yes, you'd still see many cash rates that are 5x insurance. However, many hospitals also listed Managed Medicaid insurance rates. These are generally 3-5% of list price & look for similar to normal insurance plans. So, what you're seeing may also be comparing a Medicaid rate to a very high cash rate. Will add 43284 & other gastro procs shortly. Thanks!

nugget 6y ago

In 2015 I did several months of due diligence in this market - price comparison for diagnostic imaging - before concluding that it wasn't feasible to build the product we wanted to build. This new law provides the data that we were unable to access (at scale) on our own. From the data we did get our hands on, I remember seeing price differences like $200 vs $4k for the exact same procedure. The low cost provider was usually a private practice radiologist in a small shopping mall type retail location who ran a very efficient, low overhead practice. They were terrible at marketing and ran discounts for volume from certain channels. They were only open Monday to Friday from 8am to 4pm, read times could often (but not always) be slow, they handled the least complex cases and no emergencies. Cash pay up front from patients resulting in no/minimal collections. The high cost provider was usually a large University affiliated medical center who ran a less efficient, high overhead radiology department but who also, in their defense, had to handle more complex cases as well as be open 24/7 to service one or multiple emergency departments with faster read times. Lots of fighting with insurance companies for eventual reimbursement. Lots of bad debt that went to collections and had to be written down. If you pay University prices for a simple MRI you are effectively subsidizing the ED admit who needs a complex imaging procedure in the middle of the night. If consumers start to shop for MRIs the way they shop for airline tickets - which they probably should - one downstream effect will be to remove billions of dollars of "subsidies" from the most well-resourced radiology departments in the country. If I remember correctly the diagnostic imaging market was something like $150 billion/year in 2015, and probably even bigger now, i.e. plenty of potential fat to cut.

kfarr 6y ago
Response time / availability is not something I considered in medical service pricing before but wow it makes a lot of sense.
wjossey 6y ago
For folks who don’t believe in universal medical coverage, this is part of the reason why it’s so inefficient for it not to exist. The uninsured person going to the hospital at 1AM that requires an MRI because slipped a disc in their back still ends up getting that MRI. When they fail to pay that bill, which would be 5%-10% of their annual earnings, we all still pay for it. We just decided to layer in debt collection, anxiety, and depression onto the patient in lieu of cash. As someone who still considers themselves a fiscal conservative, and also believes we need true universal coverage for all Americans, this seems like a no brainer to me at this point (and I say that as someone who would have not supported this in the 00s but has evolved significantly on this issue).
- nugget 6y ago
  My takeaway from all that research was the same. Almost everyone benefits from universal coverage but the system has to incentivize patients to shop around for the optimal balance of price, quality, and convenience. This can be accomplished with an annual deductible of a few thousand dollars perhaps capped at a % of income. Without this incentive, costs skyrocket. Price transparency is a pre-requisite without which consumers can't easily shop around, so this law is a giant leap forward in the right direction. That is the #1 most effective thing that Americans can do to reduce health care costs. #2 would be to change the standard American diet and eat healthier to reduce rates of obesity and diabetes. Almost every other proposed structural change or intervention we looked at was minimal by comparison.
  - zaphod12 6y ago
    There was an attempt at this with prescription drugs. Encourage patients to take generics by forcing a larger amount of cost onto the patients in the form of higher copays. Pharma companies realized and started giving copay vouchers (still charge insurance more, but short circuit the patient incentive). When that loophole got tighter they formed charitable foundations to give the vouchers instead. I'm not disagreeing with your points, per se. It's just amazing what entrenched interests can manage.

subhro 6y ago

> How can there be such a large difference in price for something that, I believe, is legally & medically the same procedure? I hope this never happens, but let’s say you got in a motorcycle accident and need that lumbar MRI to figure out the damage. What are going to do, get back on that wrecked motorcycle with a fucked up spine and go to that 210$ place? They do it because they can do it and get away with it.

eldavido 6y ago
I see this argument a lot. The trouble is that emergency care isn't what drives the majority of healthcare spend. What does is actually chronic conditions: dialysis, diabetes, autoimmune disorders, chronic weight conditions. That's what we need to worry about. And if there was a real market here, you wouldn't need to shop around because all the people that do, would enforce some level of price discipline on the market. Think about it. For any good sold at, say, Wal-Mart, say Gatorade, there are some people that want it a LOT, even NEED it, while others are more on the fence. There's only one price on the shelf and it's calculated to get a lot of people buying. So in effect, the people who are more indifferent (want it less) are actually doing a pretty significant service to the people who want it a lot, by guaranteeing the price will be set low for everyone. There's no reason something like this can't apply in healthcare.

LatteLazy 6y ago

>How can there be such a large difference in price for something that, I believe, is legally & medically the same procedure? If no one publishes their prices how do you set yours? 2 dollars? 2000 dollars? 2m dollars?

spaetzleesser 6y ago
I am pretty sure the providers and insurers know exactly what everyone is charging. It’s the patients that are being kept in the dark.
- deleted 6y ago
  [deleted]
- LatteLazy 6y ago
  Like any opaque market, bigger players will have more info, but I doubt anyone will share information as its collusion (maybe illegal) and also advantages either your negotiating opponent or your competitors...
  - mrnickel001 6y ago
    Exactly. Small payers are actually pretty hungry for this data. Generally, big payers are more privy to market rates (by paying for datasets, owning clearinghouses, etc).
- sib 6y ago
  When I needed a similar non-emergency procedure (cervical, rather than lumbar, MRI), my neurosurgeon, at a large, university-affiliated hospital, referred me to the in-house radiology department. Within a day or two, I received a phone call from some department at my health insurance provider telling me "Hey, we see that you are going to get an MRI; did you know that you can get the exact same procedure at providers A, B, and C, for a lot lower cost?" They did this even though the hospital's radiology department was in-network. In this case, the cost difference was similar to what's noted here - about $4,000 vs $450. Since the insurance company was paying most of it, aside from my copay / share of cost, they were motivated to provide me a little transparency. To be honest, as a patient, I would have preferred to get the MRI at the hospital; their facility was nicer, cleaner, more modern, and there was better data integration for getting the results to my neurosurgeon and keeping them as part of my holistic medical record. Nonetheless, I went to the cheaper provider.

mrnickel001 6y ago

Thanks for the feedback! We'll be improving our filter/sort here in the coming days and we'll take this feedback into our plan.

ilaksh 6y ago
My searches so far show insane differences between insurance rates and cash rates. The cash can be 5-10x higher than what the insurance company pays. It seems like a clear case of systemic fraud to me. Am I missing something? Also I am not able to find any fundoplication or LINX (43284).
- mrnickel001 6y ago
  Many hospitals don't discount from their list price for self pay. Medicare pays ~10% of list price. So, for example, if there is an insurance rate set at "130% medicare" (common to have a coefficient between 1 and 2), then yes, you'd still see many cash rates that are 5x insurance. However, many hospitals also listed Managed Medicaid insurance rates. These are generally 3-5% of list price & look for similar to normal insurance plans. So, what you're seeing may also be comparing a Medicaid rate to a very high cash rate. Will add 43284 & other gastro procs shortly. Thanks!