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Local hospital released this as an Excel spreadsheet (Chargemaster). They have a column called "Uninsured cash price." These prices are <25% of the insurance "
by Someone1234 5y ago
Local hospital released this as an Excel spreadsheet (Chargemaster).
They have a column called "Uninsured cash price." These prices are <25% of the insurance "discount" prices, but the really amusing thing is that this column was set to 0 size so that when you download the Excel sheet you have to know to auto re-size all the columns, or you cannot see it.
And, no, I don't think this was by accident as they have updated this Excel spreadsheet several times and only that one column is always set to 0 size.
- avs733 5y agoYou inspired me to look at the local hospital we just delivered our first child at. They release 'standard charges' which as far as I can tell means 'the range of charges for this particular diagnosis based on past data' as an excel file. But the price list is a text file delimited by pipes (vertical bars... |) which just seems unnecessary. They also do nothing to define the variables or column names they use...so that's nice.
- NortySpock 5y agoSometimes medical procedure names have commas in them. Instead of text qualifying them, it can be faster to write code that uses a different semi-standard delimiter. It sucks, but, like, I don't really blame people for being in a hurry to fix a problem.
- jolmg 5y agoOr they could be using a legacy system that exports data in that format from times before CSV was invented/standardized. For example, SCO Unix's Informix SQL's `UNLOAD TO <file> SELECT ...` queries output in a format that's very much like what avs733 describes, only that the values aren't separated by pipes, they're terminated by them, so every record ends with a pipe character. If that's the case, there's unfortunately no built-in option to get it to include column identifiers in the report. :(
- mulmen 5y agoIf it’s HL7 (likely) the format is more complex than just a CSV anyway. There are multiple separators for different purposes.
- EForEndeavour 5y agoThis is the GDPR cookie popup annoyance equivalent of requiring hospitals to disclose their chargemasters, but not spelling out that the published data should be reasonably human-readabale. Malicious compliance.
- KarlKemp 5y agoOh but, if you read slightly between the article’s lines, you’ll notice that the law does require both human- and machine-readable publication. The machine-readable part is mandated here: https://www.federalregister.gov/documents/2019/11/27/2019-24931/medicare-and-medicaid-programs-cy-2020-hospital-outpatient-pps-policy-changes-and-payment-rates-and#p-1010 https://www.federalregister.gov/documents/2019/11/27/2019-24... As a taste of how specific this is: (5) The file must use the following naming convention specified by CMS, specifically: <ein>_<hospital-name>_standardcharges.[json|xml|csv]. And here’s the consumer-readability requirement for 300 “shoppable’ services: https://www.federalregister.gov/documents/2019/11/27/2019-24931/medicare-and-medicaid-programs-cy-2020-hospital-outpatient-pps-policy-changes-and-payment-rates-and#p-1030 https://www.federalregister.gov/documents/2019/11/27/2019-24... They aren’t always quite as stupid as people make them out to be, these lawyers.
- EForEndeavour 5y agoFrom your second link: > c) Format. A hospital has discretion to choose a format for making public the information described in paragraph (b) of this section online. This is how you get Excel files with certain column widths set to zero. All it has to be is searchable, free, public, and updated regularly.
- mulmen 5y agoPipes are commonly used as delimiters in healthcare settings [1]. A quick quack suggests Python, Javascript and Perl ecosystems have HL7 parsing libraries available. I assume most languages do. [1]: https://en.m.wikipedia.org/wiki/Health_Level_7 https://en.m.wikipedia.org/wiki/Health_Level_7
- batty_alex 5y agoYep, probably an HL7 message. In the case of vertical bars, pretty sure it's HL7v2
- KarlKemp 5y agoExcept they usually call them “tubes”. (Can’t find the original source, but it goes “Cant breathe? Put in a tube. Can't pee? Tube. Can't poop? Tube. Bleeding? Tube. Infection? Tube. Heart attack? Tube.”)
- slownews45 5y agoGod, I used to work in medical billing, and people would think these file format issues were some kind of scheme. NO they are not. They deal with the obvious problem that clinicians are NOT always programmer friendly, and will put things like tabs in case notes, will use commas etc. At some point you use a delimiter that is much less likely to be used - | - is one of those, not a lot of clinicians use it and you can say, please don't use this. A surprising amount of stuff (at least medical billing side) can be flat file moves, especially if you are billing into lots of different systems. And yes, the idiot new person with a phD says, just quote every field with a ". Great - you program all this up, along with the required escape sequence handling, and then escapes for escapes. \ and / get used a fair bit sometimes already and we are dealing with tons of systems.
- deleted 5y ago[deleted]
- lostlogin 5y ago> God, I used to work in medical billing, and people would think these file format issues were some kind of scheme. I think it must be at this point. The hot garbage that is medical data formats (HL7, in particular) and the ways you can break it as a user, unknowingly and silently. It’s incredible that a format this bad has hung around this long. It’s not ok that users can type certain characters into a field and break the system.
- batty_alex 5y ago> But the price list is a text file delimited by pipes (vertical bars... |) which just seems unnecessary. They also do nothing to define the variables or column names they use...so that's nice. They likely just exported the prices as HL7 from their EHR system and used Excel's built-in delimiter support, then called it a day
- lostlogin 5y ago> HL7 And there is the problem.
- toomuchtodo 5y agoFile a complaint with Health and Human Services [1]. It is clear they are not acting in good faith. Take snapshots of the URL with the Internet Archive for notarization [2]. [1] https://www.cms.gov/hospital-price-transparency/contact-us https://www.cms.gov/hospital-price-transparency/contact-us [2] https://web.archive.org/save https://web.archive.org/save
- Someone1234 5y agoI actually might, the wording on this page: https://www.cms.gov/hospital-price-transparency https://www.cms.gov/hospital-price-transparency Does say "provide clear, accessible pricing information" which I would argue this is not. edit: Filed a complaint.
- toomuchtodo 5y agoI genuinely appreciate that you took the time to do so. EDIT: Thank you all for your efforts.
- splistud 5y agoFantastic. In return I will review my locals and see what they report.
- Darkharbourzz 5y agoThanks for posting this. I just looked to see if my local hospital had prices available. They have a webpage set up, but they give you a dummy link! Outrageous! I will absolutely be making a complaint. I'm also going to post a review online, since poor reviews seem to get attention from them.
- ed25519FUUU 5y agoI would think hospitals like people paying the cash price?
- Someone1234 5y agoThey make less that way. If they know you're insured they won't allow you to pay the cash price, only the much higher negotiated price.
- kindle-dev 5y agoBut someone told me insurance companies are bad and are stiffing those poor, struggling doctors and hospitals.
- jjoonathan 5y agoEvery head of the insurance/drug/provider dog points at the other two heads when somebody accuses it of being the problem.
- lotsofpulp 5y agoVoters not wanting to pay for comprehensive care for everyone is a 4th head. The current system of healthcare is great for allocating different amounts of healthcare to different classes of people, so that it is great for 20 to 30% of people, okay for 20%, and not good for 50%, and that is why it persists. There is no reason Medicare should be restricted to those over 65, or why Medicaid is implemented differently (and reimburses providers more poorly than Medicare). Or even Tricare. We have at least 3 different taxpayer funded healthcare programs specifically so not everyone can get access to equal care, but so that various classes of people can get healthcare proportional to their political power (which usually scale with money, but also votes in the case of old people).
- long_time_gone 5y ago==We have at least 3 different taxpayer funded healthcare programs specifically so not everyone can get access to equal care== Add in CHIP and the VA (Tricare). We've taken every vulnerable part of society (older, poor people, poor children, injured veterans) and given them government-paid, universal healthcare. This is around 100 million people. Everyone left over is thrown into the private insurance pool. These people are typically working age population (18-60), making them both the richest and the healthiest. This is around 200 million people.
- folkhack 5y agoAnd this can really cause issues for people who are insured because if an insurance company decides not to cover something (very very common, even in-network) then the inflated price is what you end up getting billed for. That is until you call the hospital and find out there's all sorts of "sliding" prices etc... I had a procedure billed for one of these drastically larger "insured" codes which got denied based on the nature of the procedure from the insurance company (apparently too new of a procedure at the time, however common now). It all got worked out in the end but what I realized was that hospitals are largely subsidizing the cost of the uninsured by over-billing the insured folk's insurance companies. We've set the American healthcare system up to be a cat and mouse game where those in need are represented the least. Best insurance here is "don't get sick"
- mabub24 5y ago> Best insurance here is "don't get sick" Recent New Yorker article looking at the "Costa Rica model"[0] raised this point as well. America, by contrast to Costa Rica, has a very weak public health sector and infrastructure, and this leads to a real weakness when focusing on preventable illnesses and issues. [0]: https://www.newyorker.com/magazine/2021/08/30/costa-ricans-live-longer-than-we-do-whats-the-secret https://www.newyorker.com/magazine/2021/08/30/costa-ricans-l...
- folkhack 5y agoYeah I read that too - just cherry picking here: > All adults have tests and follow-up visits to prevent and treat everything from iron deficiency to H.I.V. It’s all free. If people don’t show up for their appointments, she makes sure their team finds out why and figures out what can be done. It's common sense why they have better results and outcomes than we do here... Our system is optimized for capitalistic profit. I've got insanely good insurance and I still have no idea how screwed I am if I go to the doctor or especially a hospital. Although I've only had one major billing snafu years back I have real anxiety about going to the doctor here. And hell, even if I go my PCP is going to be stuck in an "all or nothing" mentality where it's either OTC or getting in their own conflict with my insurer... ie: "If I can't justify this test with your insurer..." --- Costa Rica's model is better than America's. The reason for this is because it's not optimized for profit, it's designed from the ground up to optimize for patient outcome.
- jweir 5y agoAnytime I have a procedure, imaging, anything I ask for the out of pocket price. You can save a lot of money doing this especially imaging.
- m0ngr31 5y agoMy local hospital offers a cash discount of nearly 50% if you pay at time of service.
- bazooka_penguin 5y agoThat sounds pretty unreasonable. Most people can barely stay on top of payments with a payment plan, let alone paying everything upfront
- phkahler 5y agoThat's why they're so eager to get the payment upfront that they'll give a heavy discount. Apparently a lot of people have trouble keeping up with their bills.
- Clubber 5y agoEspecially after a major traumatic event that requires an ER or hospital stay and especially if that bill is 5 or 6 figures.
- 5faulker 5y agoIt's like that "display:none;" thing in CSS.
- mullingitover 5y ago> These prices are <25% of the insurance "discount" prices There are some clever insurance companies whose entire model is "tell the hospital you don't have insurance, get the cash price, pay it with this debit card we give you."
- derwiki 5y agoIs it illegal to state you don’t have insurance when you do? Or is this product not considered Insurance in the legal sense?
- scohesc 5y agoThey could be running as a "health spending account" where you can spend the money on whatever you want provided it's health-related. You don't technically have "insurance" but you're insured.
- travoc 5y agoHealth care consumers are absolutely free to pay providers directly even if they carry insurance coverage.
- toomuchtodo 5y agoIt's not insurance. They're "fixed indemnity plans." Sidecar Health is the one I'm familiar with. https://www.brookings.edu/blog/usc-brookings-schaeffer-on-health-policy/2020/08/04/fixed-indemnity-health-coverage-is-a-problematic-form-of-junk-insurance/ https://www.brookings.edu/blog/usc-brookings-schaeffer-on-he... (Fixed indemnity health coverage is a problematic form of “junk insurance”)
- Y_Y 5y agoI do this. Once my insurance company got upset that my procedure was so expensive and rang the hospital. The hospital immediately tripled the price. The insurance became even more upset and asked me to fix it. Still much cheaper than the equivalent procedure in the USA. It's not illegal here, but in any case nobody asks, I just tell them I'm paying cash.
- 5y ago
- snarf21 5y agoThis is why we need reference based pricing. You can't charge more than 1.2 * Medicare and if you pay cash, you get the Medicare price. This change alone would remove 25+% of unnecessary bloat from the US system.
- nickff 5y ago>"This change alone would remove 25+% of unnecessary bloat from the US system." Where do you think the money is going? Insurance companies are not as profitable as you might think, drugs are not a massive burden on healthcare expenditures, and many hospitals are non-profits. The truth is that most of the money is going to staff wages; if you want to reduce healthcare spending, the only way to do it sustainably is to increase the numbers of doctors and nurses, so as to drive down their salaries (but this is not a popular option).
- kazinator 5y ago> many hospitals are non-profits. That can't possibly be true of a hospital that charged $3000 for something on Tuesday, and $53000 for the same thing on Friday. (Under reasonable assumptions like that Tuesday wasn't done at a $25K loss relative to breaking even; why would such be the case? And that they are busy with procedures, not simply doing a way overpriced procedure once every few weeks, and then just burning through cash in between that time.)
- nickff 5y agoVery few hospitals do cost-accounting, so they don't even know how much things cost; this results in the inconsistencies you see in prices. From Wikipedia: >"In 2003, of the roughly 3,900 nonfederal, short-term, acute care general hospitals in the United States, the majority—about 62 percent—were nonprofit. The rest included government hospitals (20 percent) and for-profit hospitals (18 percent)" https://en.wikipedia.org/wiki/Non-profit_hospital https://en.wikipedia.org/wiki/Non-profit_hospital
- kazinator 5y ago
- kingsloi 5y agoI'd love to look up uninsured prices and compare them 1-1 to what I was charged for my little girl's 2 week ICU stay https://kingsley.sh/posts/2021/two-weeks-in-the-icu-as-a-baby-with-heart-disease https://kingsley.sh/posts/2021/two-weeks-in-the-icu-as-a-bab...
- rhacker 5y agoWhat's hilarious about that - is this: Instead of giving a hospital your insurance info, say "you don't know if you have it, the last one expired" - even if you have insurance they couldn't prove you did "know you had it". Then get the bill in the mail. Submit the bill to your insurance company. Bill gets paid. Hospital doesn't get to inflate.
- tobr 5y agoReminds me of that time I exported a bunch of strings to Excel for translation. Was very confused when I got surprisingly short translations back. Turns out the translator didn’t know you could resize the rows, so they had only translated the first few words that happened to be visible in each cell.
- lostlogin 5y agoWould a local news outlet publicise this?
- elihu 5y agoIt can go the other way too. Some hospitals will charge uninsured people much more than they would charge the insurance company for the same procedure.
- gameswithgo 5y agoExcuse me. But fucking cunt asshole motherfuckers, we should be lining the people who are intentionally deceiving the public up against the wall, they are causing people to DIE.
- charlieflowers 5y agoThe most sane comment here, sadly.