34 ms·

I analyzed hospital price lists so you didn't have to

• bawana 4y ago
  The fundamental problem is that we have chosen to use a free market mechanism for a condition that is not voluntarily acquired. No one chooses to get sick. Why then should we provide choice for its solution? Can you imagine the same solution for our police? Military? Emergency services?
• rinze 4y ago
  What a strange concept, "hospital price".
  • nwienert 4y ago
    There’s always a price, you just may not pay directly.
  • hunterb123 4y ago
    Why? What do you think pays for the "hospital cost"? (That's not to say there aren't MANY opportunities to reduce the price and cost, starting with complying with the law to post prices, which many hospitals don't adhere to because the current administration isn't enforcing the EO)
    • beeboop 4y ago
      Pretty sure he's just writing commentary on the US not having a single payer healthcare system
      • hunterb123 4y ago
        I posed my question to warrant a discussion from either the commentary or faithful statement regardless of their intent. Mainly to understand the expectations, values, and reasoning.
        • beeboop 4y ago
          I don't think the concept is lost on any half intelligent adult that running a hospital has expenses and has to be paid by someone. The commentary is accurate that's is messed up to have a "price", like something is being sold. Having hospitals run off funding by taxpayers isn't a price any more than the military buying an F35 having a per-American price (and no one thinks of it that way)
          • hunterb123 4y ago
            > The commentary is accurate that's is messed up to have a "price", like something is being sold. Services are being sold, whether it's private or government ran. > Having hospitals run off funding by taxpayers isn't a price any more than the military buying an F35 having a per-American price (and no one thinks of it that way) It is a price, so is the F35, and yes more people should think that way. Whether it's being paid for via taxes collected or paid directly is irrelevant. The problem is not the method of collection of payment (taxes or direct) but the corruption of administrators.
  • petilon 4y ago
    Spoken like an American. In other countries where healthcare is not paid for by the government, the prices are readily available. Here are some examples: https://www.ktph.com.sg/patients/hospital-charges https://www.ktph.com.sg/patients/hospital-charges https://www.sgh.com.sg/patient-care/visiting-specialist/charges-payments-singapore-general-hospital https://www.sgh.com.sg/patient-care/visiting-specialist/char...
    • refurb 4y ago
      I was going to say. Singapore has universal healthcare and they want all patients to have “skin in the game”. So even if you’re destitute you need to pay something within your means, even if it’s $5 for a hospital stay.
• ramesh31 4y ago
  • haswell 4y ago
    That is not what this analysis contains. Where did you get the number 170?
  • pgrote 4y ago
    I was also under the impression it was from 1835. It is actually 1,835 modern hospital price lists.
    • PainfullyNormal 4y ago
      Good point. I updated the title for clarity.
• anonu 4y ago
  Toothless law. What article writer should do is just shame the hospitals who don't comply. Tweet at them and make it known.
  • ceeplusplus 4y ago
    It really is a toothless law, the hospital probably makes more surplus profit from price discrimination in a single week than their entire fine for the year. The damages should be increased 100x.
    • causality0 4y ago
      In my fantasy world there's a full-on constitutional amendment demanding that any monetary fine must meet or esceed the profits gained by breaking the law.
      • zeruch 4y ago
        I've long advocated for a few variations of this: 1. fines must conform to a percentage of the targets earning wealth (e.g. someone who makes 30K a year gets fined $3000, someone who makes 300K gets a 30K fine etc) 2. flat out just as you said, fine must EXCEED by a multiple, the amount they gained (however, determining the gain is in many situations, requiring a lot of forensic accounting to sort out).
        • zeruch 4y ago
          ...now I'm amused by which Ayn Rand sycophant is downvoting me because I propose proportionality so the efficacy of punishment affects evenly across the board. Y'all are the Scientology of pop-econ.
    • amluto 4y ago
      I would advocate a more direct form of damages: a hospital that does not comply may not charge more than the minimum over all hospitals in a 500 mile radius for any procedure. A hospital that does charge more and is caught must refund double the difference. Furthermore, no contractual provision may penalize patients for attempting to seek that double refund, and a class action lawsuit to recover the difference that actually goes to trial recovers triple instead. Hospitals will comply immediately :)
• mgleason_3 4y ago
  Interesting to read that only 33%-50% of hospitals comply with the law and post their prices. If there's one thing this country needs to do it's demand transparency everywhere. Especially our government. Spending. Salaries. It all needs to be public.
  • khuey 4y ago
    > Especially our government. Spending. Salaries. It all needs to be public. A lot of it is. In California for example you can go look up any public employee's compensation at https://transparentcalifornia.com/ https://transparentcalifornia.com/
    • pengaru 4y ago
      W T F https://transparentcalifornia.com/salaries/2021/gateway-community-charters/ https://transparentcalifornia.com/salaries/2021/gateway-comm...
      • SilasX 4y ago
        WTF about, not just the compensation, but the fact that some of these show a salary of $200k with $2.X million in benefits. Like, what? https://transparentcalifornia.com/salaries/2021/gateway-community-charters/cindy-petersen/ https://transparentcalifornia.com/salaries/2021/gateway-comm...
        • claytical 4y ago
          The top salaries in that database match the people's names in this article: https://www.eastcountymagazine.org/east-county-superintendents-among-11-indicted-charter-school-fraud-scheme https://www.eastcountymagazine.org/east-county-superintenden...
          • pengaru 4y ago
            Not seeing any of the Gateway Community Charter leaderboard on that list.
• Someone1234 4y ago
  When High Deductible Insurance was introduced the supposed concept was to "give employees a stake in their costs, and therefore lower them for both employer and employee." However, even today doing so is very challenging, and before laws like this it was essentially impossible. There's no way to shop around American healthcare, with the system itself working against you at every turn (e.g. doctors prescribing named brand, and you not be allowed to switch back to generic without another $100+ appointment). You can try calling and getting quotes, but they'll just waste a bunch of time and then give you a RANGE with no assurances. Even getting the quote requires your doctor to write up the entire work-order, which itself can get pushback, and or cost money. Then you have random things like for-profit life flights, which are automatic bankruptcy machines. Imagine one minute driving down the road, then suddenly waking up in a hospital, and then getting billed $80K for just the trip to get there let alone your hospital treatment or recovery. And insurance doesn't cover it. Aside but all ambulances around me are "out of network" and don't work with insurance at all. So I guess I should shop around by moving cities..?
  • mancerayder 4y ago
    I believe some states regulate that better than others. At the least, some prevent 'surprise bills' where the provider selected is out of network while the referer is in network. That's just not fair when you're unconscious or suffering.
    • bbreier 4y ago
      It's complete nonsense even when you're conscious and fine!
    • maxerickson 4y ago
      CMS took administrative action this year to try to improve those situations: https://www.cms.gov/nosurprises/consumers/new-protections-for-you https://www.cms.gov/nosurprises/consumers/new-protections-fo...
  • IncRnd 4y ago
    The Pharmacist is a doctor and can offer the generic version. They do that regularly. There is no need to go back to the original doctor you saw.
• eek2121 4y ago
  Love the post, however, your description of the problem leaves me wondering...did we work together?
• social_quotient 4y ago
  Why can’t insurance companies post the actual price they are paying and being charged by the hospital with proper billing taxonomies. They seem like they probably have these things well ironed out since they actually deal with various hospitals whereas hospitals only deal with themselves.
  • bliteben 4y ago
    There is no actual price. Its rent extraction. They can change how much they charge you for 18 months.
    • social_quotient 4y ago
      I’m guessing you’re serious. Can you link me to more info on this specific thought?
  • shad0wfax 4y ago
    The health insurance companies are now required to publish this and in fact the rule went into effect July 1 2022. Look up price transparency by CMS (the data will be published in this format: https://github.com/CMSgov/price-transparency-guide https://github.com/CMSgov/price-transparency-guide) Note: the data being published by payors in machine readable format (MRF) is MASSIVE - terrabytes of data. Example: https://transparency-in-coverage.uhc.com/ https://transparency-in-coverage.uhc.com/
  • throw123123123 4y ago
    Because they don't know it yet. They audit and review each claim a an office sends, which starts a negotiation process to see if each claimed item by the physician was warranted and done properly. All that information is codified then into a level of visit, which changes the amount it will be payed out. It is grotesquely complex, but the core issue here is that patients want to consume their healthcare through insurance, because it is tax advantaged. Thus it is impossible to make a cash business that would cut through all this bullshit for the majority of healthcare.
    • 4y ago
• remflight 4y ago
  I hate Trump and am glad he was voted out, but you have to give him his dues. This is 100% his doing, through executive action. The Dems could have done this but never did. It’s just another example of how neither side of the aisle is truly on your side.
  • system2 4y ago
    All politicians are crooks. Left or right, doesn't matter. They are both accepting bribery under "lobbying".
    • refurb 4y ago
      So when EFF goes and talks to their Senator to ask (“lobby”) for privacy laws you call that “bribery”?
    • ipnon 4y ago
      This seems like a perilous line of thinking: If all politicians are crooks, then we should get rid of politicians. Without politicians, we either have anarchy or dictatorship. Politicians don't seem so bad at that point.
      • caramelcustard 4y ago
        "All politicians are crooks" is often used as a way to discourage the public from participating in any sort of politics. Outside of this threads context – don't take it that seriously.
  • arwhatever 4y ago
    As I understand it from news articles a few months back, the Biden administration was letting the enforcement of Trump’s healthcare price transparency law really slip. And it was severely under reported. Recommend sending Biden a message (I guess via whitehouse.gov) that you’re tracking this issue.
  • legitster 4y ago
    The price transparency rule was actually an ACA provision. It just got tied up in legal limbo for a long period. It was finalized during the Trump administration, but in no way should he get 100% of the credit.
• nomilk 4y ago
  > CMS's price transparency law, which requires all hospitals to post their prices online in a single, machine-readable file Whoever got this legislation through deserves a pat on the back.
  • thedougd 4y ago
    Many hospitals and providers are ignoring it, perfectly willing to eat the fine, if it ever comes.
    • cgb223 4y ago
      I wonder if one could automate finding the hospitals that don’t do this and filing a complaint that leads to a fine like patent trolls for a cause
      • ls15 4y ago
        The competitors that do publish the data have a reasonable interest in that, so I would expect this to happen.
        • curiousgal 4y ago
          The fact that we're talking about "competitors" in the context of hospitals whose job is to save lives is incredibly broken as a non-american.
      • yieldcrv 4y ago
        If there was a bounty I would do it
  • ars 4y ago
    > Whoever got this legislation through deserves a pat on the back. That would be Trump.
    • majormajor 4y ago
• thenerdhead 4y ago
  Only way to get hospitals to abide is to complain. It’s quite sad as a person who wants to get care about an issue in their health and needing to bounce between the insurance quote and the hospital costing quote. You shouldn’t have to do napkin math to know how much it’s going to cost you in worst or best cases for simple visits, procedures, or devices/drugs. This is a positive change as you can now ask directly and hold parties responsible for a transparent price. No more ranges or “estimates”. It’s been slow rolling, but I did have success when complaining recently to my local hospital. I just hope that the fees for ignoring this start to become hefty enough to change the healthcare industry’s behavior.
• legitster 4y ago
  A chain of clinics recently opened in our area that post all of their prices online. We almost exclusively go there now for everything. Even if they are occasionally more expensive (briefly, until the normal UC would send their surprise bills), it's just so much easier to pay up front. Thankfully we have an HSA and it's our money.
  • lotsofpulp 4y ago
    If you can afford to pay for it with post tax non HSA money, then investing the HSA funds in a Fidelity HSA and letting them grow is the ideal maneuver. Pdf your healthcare expense receipts and reimburse yourself from the HSA 50 years in the future completely tax free.
  • robocat 4y ago
    HSA for those who are “international”: https://en.m.wikipedia.org/wiki/Health_savings_account https://en.m.wikipedia.org/wiki/Health_savings_account
    • cycomanic 4y ago
      That's insane! Goes to show again that the solution in the US is "be rich" and then you'll be given additional benefits.
      • legitster 4y ago
        They're usually offered as an option for work-sponsored plans. You can get a low deductible plan that your work pays $1k a month for, or you can get a high deductible plan for $500 a month and the company gives you the other $500 into your HSA tax-free (oversimplified, of course). They actually make a ton of financial sense, but too many in the US would rather overpay for insurance rather than have to shop around.
        • cycomanic 4y ago
          I agree they make sense, however they are incentive directly aimed at the rich/well off who will benefit most from this (and can afford it).
• duffpkg 4y ago
  Wrote Hacking Healthcare for O'Reilly, created ClearHealth/HealthCloud open source EMR, managed health systems for 15+ years, blah, blah, blah. It is very good there is are the transparency regulations. It is worth briefly explaining some of the reasons why many facitilities are having a hard time complying. There are some bad actors, absolutely true. However "Hanlons Razor" -- never attribute to malice that which is adequately explained by stupidity -- definitely applies. Many health systems are a lot more like "medical malls" than they are single monolithic enterprises. Lots of health systems use really, really old technology and also a lot of it from a company called "Epic". Epic does what it wants, when it wants and there is basically nothing anyone can do about it. There is rarely one central consistent mechanism and source of truth for pricing data because it gets generated from a complex web of different entities, systems, and processes. Herding all those cats is why it can take a health system a long time to comply. And also why a fine of even a million dollars can be small potatos vs the cost of actually complying in a timely manner. Just one facet, MUMPS is a widely used technology which you probably haven't heard of and which very few technologists understand. Lots of people are struggling to create new code to meet the new regulations using 1970s era technology including MUMPS. Another, a lot of health systems have been around a really long time. The insurers they work with also, (since the 1960s at least). They have Electronic Data Interchange EDI relationships built on the standard called 837. Business logic that surrounds pricing and billing is often buried in 50 years of tech debt. Everyone is deathly afraid of making too many changes too fast because when those systems break the money stops flowing and a health system will literally go insolvent. People still have hard physical lines connected to Medicare mainframes. This is a similar situation to other regulated industries like banking, airlines, etc. Modernization is hard, time consuming and very expensive. These regulations are a good driver for all that, but it takes time. Having been in some of these boardrooms there is not typically a cartel of evil executives figuring out how to screw patients. A lot of the time it is a group of relatively normal people trying to hold up a technological and business process house of cards with chewing gum, paper clips and hope. Disclaimer: I have been involved with the development of some of the fee schedules and health systems mentioned/criticized.
  • z3ugma 4y ago
    You’re right about the comparison between airlines and systems like SABRE and healthcare. You are mischaracterizing MUMPS which is now called M and has been updated many, many times since its invention and has a robust standard library of functions from M vendors.
• caramelcustard 4y ago
  Correct me if i'm wrong, but aren't some hospital bills/prices considered to be negotiable estimates? If so, wouldn't that skew the data? And yes, prices should be set in stone and be easily accessible, unless it's something that is hard to evaluate due to one reason or another.
  • lotsofpulp 4y ago
    Starting Jan 1, 2022, a healthcare provider has to provide an estimate and you are only liable for that estimate plus $400 in case of overage. https://www.cms.gov/nosurprises/consumers/understanding-costs-in-advance https://www.cms.gov/nosurprises/consumers/understanding-cost...
    • caramelcustard 4y ago
      Thanks for clarifying!
• celdon25 4y ago
  Here's a solution: Let doctors be doctors and not glorified algorithmic-assembly-line workers. Incentivize transparency through something better than Yelp reviews. Incentivize diagnostic outpatient facilities, make them more accessible and discoverable. Especially through telemedicine if possible, but make sure they can be seen in person by someone competent if needed. I'm sure I'll get downvoted here for this part, but government shouldn't be micromanaging care standards, even through a proxy like medicaid and medicare claim criteria. Let the citizens regulate the system instead, and government's job should be to make it easier for them to do so. Yes, transparency can come through price lists, but prices can never go down until quality goes up first. It's just like code quality: If it's bad, you'll have to spend more time dealing with technical debt than it would have been to invest in the quality up front. Bad medical care breeds more complicated patient situations, and the rate of seriously ill patients increases as a result. Supply cannot keep up with demand. Analyzing price lists, shaming providers into lowering prices, etc., will not solve this, nor is that idea even novel. But it may be useful as a single part of a more comprehensive strategy to solve the root of the problem. It's great for business, especially since Michael Moore's documentary made it politically incorrect to deny medical claims for terminally or seriously-ill patients. Still bad for life expectancy, but we'll probably need another "groundbreaking" documentary before the country really wakes up to the scheme. And for Christ's sake, stop training doctors to ask "what are your symptoms" (when they are already reasonably aware of what the type of issue is), and use more yes/no questioning about specific symptoms. If doctors can't be trained fast enough to be able to do even that, I'd think about fixing that, too.
  • cycomanic 4y ago
    > And for Christ's sake, stop training doctors to ask "what are your symptoms" (when they are already reasonably aware of what the type of issue is), and use more yes/no questioning about specific symptoms. If doctors can't be trained fast enough to be able to do even that, I'd think about fixing that, too. I think you really don't understand enough about why these things get asked. Yes Gp work often seems like glorified flowcharts at first glance (especially if you only look at some of their study material), but once you dig into it (I helped my partner study for an exams and get to hear her stories every day), you realise the huge amount of background information that can flow into a diagnosis. Asking the patient about their symptoms is an important part of gathering the history and can not be done just with yes or no questions.
• rootsudo 4y ago
  Nitpick, but, anyone else have issues reading the article? The grammar usage seems "off." Content is excellent, but the writing feels off.
• stevage 4y ago
  >Require a standard format. Pick JSON or CSV in some standard encoding. We don't need hospitals publishing XML files and Excel spreadsheets. Definitely CSV. Always CSV. It's easy to produce, easy to parse, and kind of human readable. And easy to do some basic analysis with tools that everyone has access to - Excel, Google Sheets etc.
  • sp332 4y ago
    I didn't like CSV because too much actual data has commas in it, so commas aren't a good delimiter.
    • slivanes 4y ago
      Quoting every column is a safe way to handle this, at the cost of slightly larger files. You can then escape a quote with another quote.
      • robocat 4y ago
        That is just one simple problem. People say CSV is hard because it is hard: https://www.delimited.dev/csv-file-quirks/ https://www.delimited.dev/csv-file-quirks/
    • patwolf 4y ago
      From the perspective of reading/writing CSVs programmatically, I actually prefer that it's a common character. You'll discover very quickly whether the parser handles escapes correctly. With a more exotic delimiter it might be a long time to discover the problem, and by then it will be harder to fix. From the perspective of writing CSVs by hand in a text editor, commas suck.
    • EvanAnderson 4y ago
      Tabs are a better delimiter than commas. Using the ASCII control characters meant for record and field delimiters are even better: https://en.wikipedia.org/wiki/C0_and_C1_control_codes https://en.wikipedia.org/wiki/C0_and_C1_control_codes
  • 4y ago
• exabrial 4y ago
  Where to start... 1. Somehow in the mid-2010s congress decided that anyway that walks onto private property, demands care from a private organization, will receive it, even if they declare they will not pay a dime to the staff working. 2. Congress could have totally create/build a system of hospitals that provides "one time care" for those people, but doesn't. 3. Instead they pass the buck and say "figure it out" to the private industry. 4. Hospitals are squeaking by largely flopping duties on nurses, making their jobs far less enjoyable (wrangling entitled individuals instead of healing people and providing care), and charing double-triple to responsible individuals who will pay for themselves. 5. E.R.s are now becoming "primary care" for large majority of the US population, as they show up, then disappear knowing they won't be stuck with a bill. 6. Members of Congress literally don't give a crap about "common folk" and go on golfing and enjoying their free healthcare for life. Meanwhile commonfolk and the poorest of the poor don't get the same deal. One set of rules for peasants, one set of rules for the 1%.
  • deleted 4y ago
    [deleted]
  • throwawayarnty 4y ago
    I wonder how member of Congress justify that they need a special health care that is different from the public. It seems to make sense and align incentives to have members use the same public systems (eg transport, education, health, housing) as everyone else, otherwise they will never understand how their policies affect real people.
    • dragonwriter 4y ago
      > I wonder how member of Congress justify that they need a special health care that is different from the public. There don't. Them not doing so is part of the ACA. Grandparent was just lying.
  • maxerickson 4y ago
    EMTALA dates to the Reagan era¹ and applies to hospitals that have contractual agreements with the Federal government (ones that accept Medicare). What else in your analysis is terribly wrong? 1. https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...
• elhudy 4y ago
  > 1)The hospitals that comply often publish the least information they can get away with 2)The CMS law appears to be written by non-technical people and leaves room for hospitals to do (1) I know the people who wrote this law. #2 is actually a false assumption. The law was written like that to incur the least resistance as a first step toward change.
• flenserboy 4y ago
  Not only do we need public price lists, the middlemen need to be cut out — specifically, the doctors. You should be able to wander into a specialist's office and get an appointment without having to go through a GP first; you should be able to get most any test done in exactly the same way. Due to the insurance companies and the hospitals they work for, doctors aren't going to suggest anything other than the basic stuff you can find through Google about a low/high count in any test. Yes, GPs are useful and have a role — but as long as their hands are tied, they're glorified flowchart jockeys. Free the data, free the patients.
  • refurb 4y ago
    The reason insurers require a referral is to keep costs down. That even happens in places with universal healthcare. It doesn’t make sense to pay for a dermatologist at $150 for a visit to look at a rash when a GP would do at $75.
  • throw123123123 4y ago
    You can do this with PPO insurance or paying cash.
    • pishpash 4y ago
      No you can't. Some specialists are referral only. They do this to satisfy medical necessity requirements to make sure they get paid by insurance.
      • lotsofpulp 4y ago
        I have had PPO high deductible health insurance for 14 years, and I have been able to see whatever doctor I want whenever I want. Obviously, I need to pay out of pocket until I meet the deductible, but it all counts toward the annual out of pocket max and I get the negotiated pricing between doctor and insurance company. After I meet the deductible, however, the insurance still pays for a consult for anyone I want to go see. Not necessarily for any procedure though, without justification. But that applies in any situation, PPO or not.
• refurb 4y ago
  I believe that this price transparency will have a pretty radical impact. I used to negotiate with hospitals on reimbursement and if I were still doing the job, the first thing is do is pull up this data and say “This other plan of similar size is paying $X. I’m willing to pay the same.” Sure it will take time to shake out. Hospitals will reject super low prices (that they were possibly losing money) for all payers. In exchange insurers will likely reduce the ultra high payments where they were paying a 500% mark up. It will likely take a few years for it to shake out, but assuming the transparency remains I could see this actually driving prices closer to cost. Sure, big payers will drive it lower and small payers will pay more, but we could start to see a much smaller range. Fingers crossed.
  • pishpash 4y ago
    What's cost though? You've seen inflation when the supply chain is constrained. This is the case with medicine so the cost is possibly infinity here.
• deleted 4y ago
  [deleted]
• sl-dolt 4y ago
  I'm as surprised as anyone to see this #1 on HN. Glad y'all like it. AMA. Feedback, criticism, comments, directions to go, whatever.
  • JohnJamesRambo 4y ago
    I wanted to see how different the price for the knee replacement would be at different hospitals.
    • sl-dolt 4y ago
      Good point. With the data as sparse and dirty as it is, it's hard to get a reliable analysis for specific procedures. Or at least one I consider publishable. That, plus, I don't have a good understanding of how medical billing works on the inside. Some of that will hopefully change in the coming months as new data comes in (will write more about that in another blog.) If you want to look at how prices for different procedures can vary between hospitals, you can get a rough idea from a previous blog post I wrote: https://www.dolthub.com/blog/2022-05-06-the-most-expensive-hospitals/ https://www.dolthub.com/blog/2022-05-06-the-most-expensive-h...
    • lotsofpulp 4y ago
      You can simply ask the hospital to give you good faith estimates: https://www.cms.gov/nosurprises/consumers/understanding-costs-in-advance https://www.cms.gov/nosurprises/consumers/understanding-cost...
  • joshgel 4y ago
    > You have to hope your hospital uses CPT codes and not, say, DRG coding, or something else entirely, otherwise you'll need to look up those codes too. This is a bit of a misunderstanding. CPT codes are part of professional services billing, while DRGs are exclusively for inpatient acute care billing. If you are admitted to a hospital, you’ll probably have to deal with both.
    • sl-dolt 4y ago
• peterfield 4y ago
  Great stuff thanks a lot
• brundolf 4y ago
  Despite all the problems with the law and with compliance, I'm optimistic about this. I think various orgs are going to ravenously pick apart this data, normalize it, make it easy to use for regular people, etc. Gaps are gaps, but messy formats and inconsistent codes and such are the smallest of speedbumps, in my mind. Journalists, nonprofits, and startups are going to extract every bit of juicy truth there is to find in this stuff. They're going to get to the bottom of every cryptic string by hand if they have to, because there's so much value in this for nearly our entire society. And hopefully, the fines will mean the true gaps get smaller and smaller.
  • pishpash 4y ago
    I'm not optimistic. The data that has been out there for years has not yielded end-user usable information. There is too much missing context and billing trickery that it's not possible to tell how much something costs unless you're a medical coder.
  • deleted 4y ago
    [deleted]
• vivegi 4y ago
  A few routine billing concepts that skews line item amounts in raw claim dumps or price lists derived from claim dumps: - CPT modifiers (The service or procedure has both professional and technical components OR More than one provider performed the service or procedure. More than one location was involved OR A service or procedure was increased or reduced in comparison to what the code typically requires etc.,) - Bundling (1 line item as opposed to 2 or 3 when the second and third procedures are an outcome of the first. eg: bone-xray + procedure(s) to fix the broken bone detected through the x-ray) - Rendering provider vs. Billing provider (Rendering provider is the physician or provider that provided the service and billing provider could be the hospital/clinic/lab/ambulatory/billing company etc.,) But here's the kicker. Medicare is the largest payer in the US and it already has a Fee-for-service pricing schedule. You can be sure that it covers all states, locality-wise price adjustments, hospital density factors in the price schedule and every possible procedure billing scenario. So, one just needs to compare (within a ZIP code or County or other geographic area) the hospitals prices against this to find anomalous pricing issues.
• ddingus 4y ago
  Frankly, this exercise motivates me toward universal care more than ever. I do not mean to devalue the work. It's great honestly! Thank you. That said, this is a major league mess most of the world would look at and wonder whether we are crazy or high.
  • gjulianm 4y ago
    Yes, as someone outside the US, the fact that this is a thing is just... weird. When I go to the hospital I'm already worrying about health, I'm thankful I don't have to worry about money too.
    • ddingus 4y ago
      It can be rough. Cost me a home once! Right now, it appears the US will have to learn this all the hard way. The financials are super attractive for people at the business level, and can be compelling for care providers, who may have expensive school to pay down. For most everyone else, including many employers, it is increasingly painful. The nature of the issue also makes change hard. Many people do not want to disturb what is working for them however painful. Can't blame them.
• killjoywashere 4y ago
  This healthcare thread is amazing, I want to meet you all.
• bradwood 4y ago
  I live in England so I don't have to either.
• dmje 4y ago
  I did it for the UK. It didn’t take long :-)
• rob_c 4y ago
  And for the NHS at point of use (when you can get to the to of the queue): 0$ 0$ 0$ 0$ 0..... Genuine wishes of good luck to those in dealing with that system and may you avoid it for as long in life as possible.
• kelexj 4y ago
  [flagged]
• kelexj 4y ago
  [flagged]
• godmode2019 4y ago
  Was this not a Trump policy?
• camillomiller 4y ago
  I analyzed Italian hospital costs so you don't have to: it's 0.
  • Mordisquitos 4y ago
    Your sarcastic comment was ironically invalidated by failing to copy the headline exactly. I assure you that the costs of Italian hospital are much, much greater than 0. Now, their prices on the other hand, that's another matter...
    • camillomiller 4y ago
      I love this comment
• black_13 4y ago
• jacquesm 4y ago
  American hospital price lists. If you want this to improve: get rid of privatized health care. There are plenty of countries that set the example on how you could deal with this in a far more humane and fair way.
• lr1970 4y ago
  This study uses polars [0][1] -- a new Data Science library written in Rust (core) with bindings to Python and Javascript. Perfect replacement for pandas. Polars' claims to fame are speed (faster than pretty much anything out there [2][3]), low memory pressure (very visible when comparing to pandas) and consistent API across Rust, Python, JS. [0] https://www.pola.rs/ https://www.pola.rs/ [1] https://github.com/pola-rs/polars https://github.com/pola-rs/polars [2] https://h2oai.github.io/db-benchmark/ https://h2oai.github.io/db-benchmark/ [3] https://www.pola.rs/benchmarks.html https://www.pola.rs/benchmarks.html
  • this_is_not_you 4y ago
    Thanks! I had not heard of it before. As a Python pandas user I have to say this look really promising. The speed claims are obviously great but what really stood out to me is the syntax. Reminds of the the dplyr syntax which I enjoyed a lot when I was still using R.
• fapi1974 4y ago
  Does anyone know if the 2019 law opens hospitals to civil action or whether individuals can be awarded some portion of the fines for reporting as in whistleblower cases? If so, that could be a decent alignment of incentives to get the hospitals to comply.
• AdamN 4y ago
  Having recently moved to Germany from Seattle ... it really is nice to not have to worry about this stuff. This is especially true since I have leukemia and take medicine daily. At some point I'll have a big frustration with the German healthcare system I'm sure, but it hasn't happened yet.
• formerkrogemp 4y ago
  From an accounting and compliance perspective, not complying might make sense depending on the cost of upgrading systems. Hospitals and healthcare networks are going to upgrade their systems piecemeal and hodgepodge as their funding allows and pay the fines in the meantime. It'll be a good time to work in healthcare IT consulting. I'd imagine revenue will increase as EMR and so on require updates due to changes in regulation, assuming that we continue this trend.
• zugi 4y ago
  If the law were serious about medical price transparency, it would just state that no medical bills are valid or enforceable in any court unless the exact price is clearly disclosed to the customer and agreed upon up front. Without relying on any government enforcement, we'd see an end to surprise billing overnight. Business practices would have to change. In cases where the all the steps and treatments aren't knowable up front, providers would have to pick a price and stick to it - like any business or service provider they'd make money on some and lose money on others. Instead of issuing separate random bills from various providers, hospitals would have to pay their subcontractors out of their fixed prices, like a normal business. There may be exceptions for emergency care but those would be the rare exception, not the rule.