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Leaked Scripps records reveal automated mark-ups for hospital care
- olliej 5y agoI'm mostly surprised that nurses and doctors were able to see the mark ups being applied. I'm sure that the next update will "fix" that. How these markups don't run afoul of price gouging laws is beyond me :-/
- egberts1 5y agoHospitals and specialists should be made to post prices of their services … by law.
- xyzzy21 5y agoPublish ALL prices prior to admission. There are hospitals overseas who precisely publish their prices for standard procedures. This is why pre-COVID I would travel overseas for any medical procedures that could be scheduled ahead of time: it was a known, low variance expected cost. There is no reason not to public pricing short of fraud, conspiracy and lack of ethics. We are already seeing exactly how much ethics/morals much of the pharma, health care and public health of USA actually have (i.e. next to NONE).
- jedberg 5y agoWe have that law in California. Enforcement is lax. Sometimes it's a single piece of paper up on a wall in a hidden corner. Sometimes they don't have it at all. But at the end of the day, it's not like you're price shopping when you're having a heart attack. You're going to the closest hospital and sorting out the cost later... which is exactly what they are counting on.
- drdec 5y agoThat is the law in the US as of January of 2021: https://www.cms.gov/hospital-price-transparency https://www.cms.gov/hospital-price-transparency
- KoftaBob 5y agoThey are, as of January 2021. The effects of that will take some time to be seen in pricing.
- 0xcde4c3db 5y agoEven if you have the list, there's not necessarily any way to be sure in advance which price(s) you'll end up paying. The whole system is built around an incomprehensible fog of "discounts" and idiosyncratic distinctions among similar procedures.
- yborg 5y agoI'm wondering what it will take to stop this, it's basically institutionalized loan sharking across a giant chunk of the economy critical to society. The entire market, from insurance companies to providers is falling over itself trying to out-gouge the consumer because there's no repercussions. And why aren't there startups out there coming to compete for this gigantic money pool by offering a mere 400% markup?
- poidos 5y agoEither socialized or nationalized medicine. Removing the insurance companies entirely removes the price-gouging they do from the equation. On the non-insurance front, every hospital and care provider is then required to either - negotiate with the government on prices, or - work for the government, charging their rates.
- dontcare007 5y agoAnd then waste and graft moves from a semi-accountable company to a group that has the use of force to enforce their policies. No thanks.
- jatone 5y agothe fact you think insurance companies are accountable is laughable. last I checked I never could decide on what insurance provider my employer offered. I see no difference between private insurance and government run except the government is constantly lambasted for overspending and medicare seems to have the lowest operating costs and payouts to healthcare providers. which seems to be the exact metric you want. edit: just move to a public option system and watch shit hit the fan in the market.
- handrous 5y ago> I see no difference between private insurance and government run except the government is constantly lambasted for overspending and medicare seems to have the lowest operating costs and payouts to healthcare providers. Contrary to popular understanding, relatively low (sometimes impressively low) overhead & even fraud rates is the norm for US government social programs. This is one case where pop-culture "common knowledge" diverges wildly from reality.
- tastyfreeze 5y agoThis is what happens when the buyer doesn't care what the price is because its not their money and the seller doesn't publish prices to allow comparison. Insurance companies only care if a price is outside of "normal" as they can just increase premiums as hospitals push "normal" continually higher. Hospitals make ridiculous profit. Insurance companies make ridiculous profit. Neither of them care at all what the real customer gets charged. See also Federally guaranteed student loans
- afsafsaf 5y agoShouldn't the insurance company care because if they can reduce their premiums, they can be more competitive for employers/purchasers? I don't understand why the insurance company isn't cost driven.
- pmalynin 5y agoInsurance companies are require to put a certain % of the premiums towards actual healthcare. In other words administrative fees (read profit) is capped as a % of the premium. The higher the premium the higher the profit.
- huitzitziltzin 5y agoAdministrative fees =/= “profit”. That is wrong. Administrative fees include profit, but also salaries, IT expenses, whatever other costs it takes to actually run an insurer.
- s1artibartfast 5y agoIs the rest correct? That is to say, there is an incentive for higher overall insurance spend, because it allows for higher admin fees (including profit)
- SomewhatLikely 5y agoThese ridiculous markups existed before those caps imposed by the ACA.
- eecc 5y agoThe only change will be the introduction of Field Level Security to hide this information from screens for the wrong RBAC role
- cardiffspaceman 5y agoSo I think a lot of us in this forum had the same thoughts. But we also know a plausible story for how this person got her access: The original access level was sufficient for 85% (let's say) of her duties, and after she went to the other person for what she needed the other 1/7 times, they gave her the broader access level so she could do her job without interrupting someone at a higher pay grade, or on a different floor.
- kingsloi 5y agobillable amount = (pain_and_suffering / 2) + 7
- ethbr0 5y ago> I started asking questions,” the nurse said. “I was told that if we didn’t mark things up like this, insurance companies wouldn’t give us what we want.” > Healthcare providers routinely ignore the actual cost of treatment when calculating bills and instead cook up nonsensical figures to push reimbursement from insurers higher. This is the real story of health care, in a nutshell. Providers say "A procedure costs $100." Insurers say "Great, we'll reimburse you $50 for it, or you won't be in network." Providers say "But it actually costs $100." Insurers say "Fine, but cut us a deal in exchange for our business, and charge us $50." They hammer out a contract that specifies $55 for that procedure. On the next procedure, which costs $200, the providers (and their facility) stops to think. "Wait, insurance is going to ask for a substantial haircut on whatever number we give them." So providers say "This procedure costs $400." Insurance says "Fine, we'll reimburse you $200." Providers say "Oh no. Fine, we'll take it." Then a few years later insurance analysts get around to noticing relative cost differences, and the entire dance starts over again. The fundamental problems with US health care are (1) the lack of end-user (patient) visibility into costs before undertaking a procedure, (2) opaque insurance-facility contracts, & (3) the bullshit dance between facilities, middle people, and insurance companies that end up adding confusion, delay, and costs to what would otherwise be simpler transactions.
- mjevans 5y agoWhich is why I try to vote for politicians that support any kind of single payer / medicare for all / etc healthcare and was so very disappointed with what Obamacare became: just payouts to the established anti-consumer groups as usual.
- jimbob45 5y agoI don't understand your point on #1. What good is visibility going to do me? I have only so many hospitals reasonably distant from me in-network such that competition isn't likely to substantially alter my price, I would think.
- ethbr0 5y agoThe point with visibility is that it's a necessary precondition towards establishing an actual market. Or to put it another way, without it, you certainly can't answer the question "Where is the best deal for my procedure?" But more importantly, you can't even answer "Are my insurer's negotiated rates a good deal for the procedure?"
- tyoma 5y agoI am a Scripps customer. Their prices are not different than any other healthcare system in the area. They all do this; Scripps just made it more obvious how prices are actually set. And since this has been brought up in the thread: Scripps is already a non-profit! Their domain name ends in .org. They routinely ask for donations.
- huitzitziltzin 5y agoThis is an infuriating but not surprising read. The only surprising thing to me is to see the number written down. (And that some part of the system was available to a nurse to see!) I’m a health economist and much of my research is on hospitals. As much as everyone loves to complain about drug companies and insurers as being responsible for high US health care costs, that is not where the money goes. The money goes to doctors and to hospitals. (Specifically: about half of all national health spending to those two groups.) If you want to save money on health care, you need to talk about paying less to doctors and to hospitals. If you don’t want to pay less money to those two sets of entities, you aren’t going to save much money. That’s all there is to it. Yes, we can do better by spending less on drugs, but it’s a small amount compared to the gigantic sums which go to doctors and to hospitals. (Specifically: all drug spending is about ten percent of national health spending.) Yes, we can do better by reducing the administrative burden, but that slice of the pie is less than 10%. (And you will never have 0 admin expenses.) The administrative burden of health insurance is even lower than 10%. So… go ahead and share your ideas for paying doctors and hospitals less, because otherwise you’re talking about stuff which doesn’t amount to much!
- YossarianFrPrez 5y agoFascinating. I have some questions I'm hoping you can answer. Can you speak to the narrative of administrative bloat in US hospitals? Are doctors paid relatively less in other countries? And is there any chance that the high pay is needed to counter-act overly stressful working conditions in the US (vs., say, the UK's NHS?) I'm also curious about doctors' personal expenses. If most of their salary is going towards rent or homeownership, short of situating a hospital on something like a kibbutz... maybe there is some sort of rent subsidy -- or tax break for landlords that give a 10% rent discount / for banks that give a medical professionals low interest home loans -- that could be enacted. It could allow doctor's effective salaries to stay the same, but medical prices to drop? I'm afraid you are going to say that doctor's biggest personal expense is student loans for medical school! If medical-school-debt were to be wiped out, do you know how much salaries could drop in terms of objective price without changing doctor's effective income?
- 5y ago
- servytor 5y agoColleges are the exact same - once it becomes standard for an intermediary to handle the bill, the costs skyrocket. From the government giving anybody who goes to college a loan, means that colleges can charge insane fees despite no change, and hospitals charge insane fees because it is standard to gouge insurance.
- kevin_thibedeau 5y agoPart of the problem is the loss of mutual insurance which makes executives accountable to their members and forces profit sharing.
- setgree 5y agoThis is a minor quibble, but this sentence: >Scripps’ automated system took the actual cost of sutures, imposed an apparently preset 675% markup and produced a billed amount that was orders of magnitude higher than the true price. was jolting for me as a reader -- going from $19.30 to $149.58 is an increase of around one order of magnitude rather than many.
- efitz 5y agoAs with anyone who has a soul and a conscience, im shocked by health care costs. A lot of people say this is a failure of capitalism. It is precisely the opposite- it’s regulatory capture. Healthcare and insurance are among the most highly regulated industries in the US. All that regulation has had decades to fix the problem and hasn’t; it’s caused the creation of workarounds like “charge masters” and “pharmacy benefit managers” that make prices more opaque. Why do we even allow negotiated price for insurance? Sounds like antitrust/price fixing/collusion to me? Why doesn’t each health care provider publish their prices and the insurer publishes what they’ll pay and the patient is responsible for the difference?
- mwerd 5y agoSnooze. What is charged in healthcare is a distraction. This is likely a supply that would be used in an inpatient setting and will be completely written off as a "contractual discount and allowance" after the insurer pays the negotiated rate, which is based on the overall case and it's severity, not what supplies are used. This is lazy journalism meant to generate outrage without discussing the substance of the problem. Relax medical licensure requirements. Cap medical malpractice damages and chase the doctors' licenses instead of their pocketbooks. Allow nurse practitioners to provide higher level care. Allow telehealth and reciprocity for out-of-state licensure. Publicly fund more medical schools and residencies. Reduce burdensome documentation requirements and Medicare billing audit penalties. Just a few ideas that I think are more meaningful options for addressing healthcare costs.
- jl2718 5y ago1. End all insurance mandates 2. Allow fee-for-service Medicare.