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Health insurers just published close to a trillion hospital prices
- metadat 4y agoWhere is the raw 50-100TB of compressed data available for download? Is it fully public or does it require registration to access?
- sl-dolt 4y agoIt's all fully public. Here are some tools that will get you the negotiated rates links along with the sizes of all the files: https://github.com/alecstein/transparency-in-coverage-filesizes https://github.com/alecstein/transparency-in-coverage-filesi... This won't get you all of the insurers, but it'll get you a a few of the major ones. If you want links to the files of more insurers, here's a project from one of my friends at Postman: https://github.com/postman-open-technologies/us-cms-price-transparency https://github.com/postman-open-technologies/us-cms-price-tr...
- sajacy 4y agoSo - veteran data wrangler here. I skimmed some of Humana's files. There's lots of repetition that can easily be removed when converting from a raw input to an analytical dataset - basically the huge blocks of text in "BILL_TYPE_CODE: 130,139,..." in the ADDITIONAL_INFO field can be normalized away by building a quasi-Huffman-encoded lookup table. Noteworthy(?): there seems to be a limit of ~100~ 140 sets of prices, as seen in the filenames: 2022-08-25_NNN_in-network-rates_0000000XXXXX.csv.gz ~Did I miss something? ... or is this some kind of technical limitation for Humana?~ Edit: I missed the alphabetical ordering. Still, only about 140 price sets. Also, each plan member's JSON file has a small chunk of useful information, then a useless list of all 15k gz parts of a relevant NN_in-network-rates file (you only need the first filename to figure out which NN to reference). For these files, you can use Range requests to download only the first, say, 50KB, and pipe it to gunzip and jq. (https://github.com/stedolan/jq/issues/31#issuecomment-900184378 https://github.com/stedolan/jq/issues/31#issuecomment-900184...) I would also be interested in helping throw such an analytical dataset into BigQuery. It'll be great for sharing an open dataset. No doubt this will still be a gigantic headache, but it is tractable.
- sl-dolt 4y agoLove the insights! Making a note to dig deeper into this. Feel free to reach out to me via email as well if you want to discuss more: alec@dolthub.com
- bravura 4y agoCould we rename the title to: "Health insurers just published close to a trillion hospital prices" This post is lot more interesting and important than the current short title would suggest.
- coding123 4y agoMaybe good, maybe bad. I suspect the good will be lower prices as we resolve major conflicting prices for the same service. Maybe bad as we find that nurse Jackie is spending too much time taking care of your sick husband and that needs to cut back as the prices the hospital is negotiating drops. The service will become more standardized and robotic.
- RhodesianHunter 4y agoAnyone else get the feeling this is malicious compliance on behalf of the insurance companies? "Oh, they're going to force us to publish our prices are they? Well we'll publish so much data it'll take a herculean effort to make it readable to anyone that doesn't work in data engineering"
- axus 4y agoThe article mentioned CSV files, it seems more like a reflection of what a huge bureaucracy the US healthcare system is. I liked their suggestion that the government should have created the database as part of the law, done the processing on the raw data, and made it more accessible.
- lumost 4y agomeh, I'd prefer the raw data. We can always create DBs out of the raw data, we can always link data. Handling this after the fact would be impossible. Linking a few trillion records doesn't seem that difficult. It should be doable with a good data warehouse and a reasonable entity linking model. I suspect that we'll find more than a few instances of fraudulent behavior once the data is linked. My father was nearly pushed into ~2 Million dollars worth of brain surgery that was unnecessary. Not only was the procedure unnecessary, the price for it was >5X what a top-3 hospital would have charged. I only became privy to this once I pushed him to come to Mass General Hospital (MGH) for a second opinion. The surgeon we saw at MGH also believed the suggested procedure to be dangerous. I wonder if it's possible to cross-reference mortality/complication rates with prices...
- A4ET8a8uTh0 4y agoIn their defense, if it was anything but CSV files, they would be accused of making it too complicated/locking into proprietary formats and so on. I can't say CSV would be my first choice, but I don't really want to think what the alternative would be.
- Victerius 4y agoMillions of .xlsx files
- jamestimmins 4y agoSeems like every week there's a new massive scale DB project or company getting announced on HN. If they're looking for projects that create public value and demonstrate the power of their products at scale, digitizing this and making it searchable may be a good marketing project that's appealing to certain kinds of customers.
- sl-dolt 4y agoFiguring out the size of this data was part of the research phase for doing just that: building out that database. I'm curious to know if other people are already working on it (maybe Turquoise Health?)
- ageitgey 4y agoYep, we have built this database at Turquoise Health. I agree, the data is massive - and don't forget that it is all refreshed monthly!
- JackFr 4y agoIs that from the hospital side or the insurer side?
- withinboredom 4y agoIt’s my understanding these prices are negotiated to some degree, so it’s probably both sides at various times.
- ageitgey 4y agoWe have built databases for both and can compare between them.
- jamestimmins 4y agoIt's cool seeing that Turqoise Health exists. One of my first programming projects back in the day (when I was trying to get a jr role in 2014) involved building a simple version based on data.gov medicare data. The inputs were terrible and tiny (e.g. chest pain at hospital X costs ~$60k on average across 5 patients), so I was always curious what a real world version might look like. edit: As I reflect, I'm amused to recall that this was early enough in my path that I didn't know about DB indexes, so I was very proud that I figured out how to basically roll my own indexes by pre-sorting the columns by lat and lon. I don't remember whether my solution actually prevented a full-table scan, but it felt like a major breakthrough at the time.
- planetsprite 4y agoI wonder what percentage of work in the US healthcare system is completely unnecessary from a general perspective but made necessary deliberately to justify the unethical system that allows millions to die unnecessarily.
- suoduandao2 4y agoJudging by the US's price/outcome ratio compared to other developed nations, a little over half[1]. [1]https://www.pgpf.org/blog/2022/07/how-does-the-us-healthcare-system-compare-to-other-countries https://www.pgpf.org/blog/2022/07/how-does-the-us-healthcare...
- ChrisLomont 4y agoWhy that article points out the US spends $12k/capita on healthcare the singles out administrative costs at $1k/capita while ignoring all the other relevant factors is beyond me. They then use the misleading infant mortality stat, ignoring that the US considers vastly more babies viable than any other country, meaning we try to save infants that other countries write off, thus they count against the US when it fails, but not against the other countries that don't count them as viable. It's a really poor article ignoring important nuance in what it presents. The US pays about twice per nurse or doctor in the system, and part of that is because the US pays nearly twice for most skilled work. So, to get prices like most other developed nations, we would be forced to cut nurse and doctor salaries, which would likely lower quality of workers as future workers went to more lucrative fields, which would likely lower outcomes. The US can have higher cost or lower quality. How would you make this tradeoff?
- Judgmentality 4y ago> So, to get prices like most other developed nations, we would be forced to cut nurse and doctor salaries, which would likely lower quality of workers as future workers went to more lucrative fields, which would likely lower outcomes. Why are you ignoring all of the costs that go to people besides nurses and doctors? I know very rich people whose entire careers are built around selling overpriced products to hospitals. These people are leeches that provide no value other than profiting off of dumb compliance laws. If you can buy the same product at any store for 1/10 the price, there is no benefit to requiring it be gatekept by people whose sole incentive is squeezing blood from a stone. Get rid of graft. The problem is the system and the incentives it creates. US healthcare is dictated primarily by insurance companies who care more about maximizing profit than providing healthcare. To fix the system you start with increased transparency, then you focus on accountability. Why do we allow such blatant corruption? Let's get rid of all the leeches first, since they provide no actual value while jacking up prices. There are so many areas we can improve results and cut costs before we address the salaries of doctors and nurses.
- nojito 4y agoThis data is already available cleaned here. https://turquoise.health/ https://turquoise.health/
- JackFr 4y agoI think that's hospitals not insurers.
- sl-dolt 4y agoI know it's not in the business interest of Turquoise Health, but I'd like to see that data be downloadable. There's a lot of insight sitting in the data. This blog was a feasibility analysis to see what kind of work it would take to get that data. If we do get it, we plan on making it free to download.
- hoppyhoppy2 4y agoThose are hospitals' cash prices, not the negotiated rates with insurance companies.
- nojito 4y agoNo they have everything. https://turquoise.health/researchers https://turquoise.health/researchers
- mesozoic 4y agoSay someone ingests this data and clean it up make it usable, who's the customer for that service? What would they want to know from it?
- 55555 4y agoI want to be able to visit a website, select my hospital, the procedure, and my insurance, and see what it will cost. Next to the result, please show me how much the same procedure would cost with the same insurance at other hospitals near my location. You will literally save American lives.
- muhammadusman 4y agoTurqoise health kinda does this now, not as robust yet but I have been using it to check out prices. Hopefully, your use case becomes a reality soon.
- llanowarelves 4y agoRestoring sanity and making it like any other product or service.
- dvaun 4y agoI think that there is opportunity for some neat visualizations with map overlays, average costs of various categories of procedures, etc. As for the customer, I wouldn't know.
- sp332 4y agoA patient wants to know how much a procedure will cost. Now the hospital can look up that data, since apparently (from experience, not hyperbole) no one who works there actually knows.
- MatthiasPortzel 4y agoI work for a company (https://careviso.com https://careviso.com) that is in this space. We will sell our benefits investigation services to providers (hospitals, clinics) so that they can give better information to their patients. However our main customers right now are labs that do diagnostic testing. What we've been able to do is build data-backed algorithms to determine whether a given patient's health insurance will cover a given test. Since patients are (obviously) more willing to get tested if they know that their insurance covers it, labs that work with us can increase their volume. Labs' sticker price for tests can be thousands of dollars, and they don't want to advertise that. They need information about what insurance the patient has and whether that insurance will cover a given test. I think most of our data is internal data we've collected, but the Price Transparency Act is definitely useful to us in delivering accurate estimates. (This is an oversimplification of our system. If you work in the space and want details, I'm sure our team would be happy to talk with you.)
- TimTheTinker 4y agoI would love to hear from an insider on what the difference is between these published files and the internal databases - I'm sure the difference between the two is striking. Malicious compliance, indeed.
- chevman 4y agoIt's really not malicious. What you are seeing here is essentially part of the claims adjudication process output. This takes as input the procedure (ie the ICD/CPT code) and the provider, and runs it against the 'plan design' (which essentially is what includes the provider networks and the associated negotiated rates per procedure) and outputs the resultant cost. Same can be done on the PBM side, just substitute drug for procedure, and 'formulary' for 'plan design'. The interesting question when you look at cross plan, cross provider, and cross carrier variances, is why :) Many companies, careers, and lawsuits, are being born from this data drop. Will be fun times the next decade or so to see how this plays out.
- valayal 4y agoInternal systems are rules engines with hundreds of branches for the most seemingly simple claims. If every payer tried to encode the rules instead of the outcomes of those rules, it would also be entirely unusable, but for a different reason. There is no standard way to encode these contract rules. There aren't any constraints on the legal language that can exist within a contract. When CMS passed this regulation, lots of insurance companies were stuck with systems that flat out could not generate this output. They then had to pay millions to consultants to crunch historical data in order to create these files (which, by the way, is technically not in line with the regulation -- historical data should NOT be used to generate these files). CMS defined in painstaking detail the format and content of these files. Health insurance companies flagged to CMS early on that this would result in a huge amount of data, but at least at the end of it all you get a bunch of dollar amounts, instead of legalese.
- gigatexal 4y agoPrice transparency is an essential part of a healthy market. Or so says the theory. I hope they release it. I wonder what I can do to help? I’m capable in db design, sql, etc being a data engineer by day perhaps I can help this effort.
- sl-dolt 4y agoI'm the author. A question I have is: how did so many prices ever get negotiated in the first place? What kind of systems are in place to do this kind of micro-negotiation?
- gffrd 4y agoSuper curious about this, too. Also! What did they do before they could store 100TB of pricing data? How has pricing (and care quality) changed as a result of being able to do this type of thing?
- yojo 4y agoPossibly the original data is logically compressed. E.g. payer A pays 110% of our standard rates, payer B pays 85% of our standard rates. Those two rows could translate into thousands of CSV lines depending on the number of procedures. Maybe you have a couple one off negotiations for high volume procedures, but even still the source data could be several orders of magnitude smaller than the dumps.
- acchow 4y agoThey are obviously not computing pricing this way. Their pricing system applies rules. But they are dumping every possible combination.
- kderbyma 4y agothis would be a great social study. cases where technology has enabled the racketeering and price gouging by corporations with almost no gains in efficiency or output or quality or any metric of value.
- thechao 4y agoAny time you can convert a problem from an `N x K` problem to an `N + K` problem, there's some asshole administrator trying to turn an `N + K` problem into an `N x K` problem. It wouldn't surprise me if there's huge amounts of redundant information in there.
- 4y ago
- hyperbole 4y agoThis seems very much like the episode of Veep'Boxes of lies' where they try to hide their nefarious deeds alongside the real day to day inter-workings of the vice presidents office but inundating the public with data.
- anigbrowl 4y agoThis is a common strategy in litigation as well - if someone complains that you have pricked them with a needle, dump haystacks on your opponent's doorstep while also insisting on your right to a speedy trial.
- cwillu 4y agoUnrelated: “dolt” vs “doIt” is one of my standard font competence tests
- mskar 4y agoI work in data at https://www.carrumhealth.com/ https://www.carrumhealth.com/, and I've been parsing this data for weeks. The transparency prices allow us to meaningfully negotiate with providers, and make tangible, incremental progress toward cheaper health care. Providers and existing insurance carriers leverage information asymmetry to control the market otherwise. For context, we bundle the 100's of itemized costs into a single, static bill per surgery type. In doing so, we've built a custom virtual-network with the most efficient surgeons. These surgeons are able to meet the volume and quality requirements to allow for lower margins. We're able to get negotiated rates that are 10-40% cheaper than traditional insurance contracts when we have data that we trust. Unfortunately, this data alone isn't enough to properly determine prices because organizations will spread costs across procedure and billing codes that often occur in aggregate groups. For example, in a joint replacement surgery, some organizations may dump the cost into the billing for the implant itself, while others may put it under the procedure code. You have to gather billing data en masse to see which charges occur together, then combine this pricing data to determine what costs will actually look like for someone experiencing a procedure. It's a nightmare!
- riskable 4y agoHow much do you think it costs to maintain all these negotiated contracts VS just having a single payer system with the same price for all procedures?
- mskar 4y agoIt's very expensive, carriers have an economic incentive to simplify it and this is still where they end up. There are a long tail of provider circumstances that the single-payer model will need to figure out. Some examples: * Small hospitals in low-density, underserved areas have to make up for underutilized equipment and personnel costs. They raise prices on unrelated, common procedures to break even (This is very common) * CMS (medicare/medicaid) sets a low price for a procedure that's overly common in a particular facility, now that facility loses money for each occurrence. They choose other procedures to raise the price to try to break even. * Larger hospitals have higher administrative and operations costs (for things like training and research) that benefit society, but need to be averaged out across all procedure costs. This differs from hospital to hospital. * Smaller professional facilities or physicians groups (like Ambulatory Surgery Centers) have much lower administrative costs and a smaller staff, so they have lower overhead per procedure. They are designed to be efficient, and can handle lower prices. However if there are any major complications, they won't be able to service the patient, and have to send to a hospital. This then pushes all the highest-cost, ICU-type procedures into hospitals, where there is already a higher overhead, causing hospitals to need separate pricing to cover more complex patients. A large single payer price set will probably force efficiencies into the healthcare system. It'll be great for folk's costs, but we may see many facilities close, and lines of care will be consolidated into specialty centers. (more travel to get imaging, procedures, or to see a specialist)
- Titan2189 4y agoSomeone with the right connections should call up Google Cloud and ask them to ingest the data into BigQuery as an example dataset like the NY taxi trips. It would be a great way for them to show off the capabilities of the engine and helpful for everyone wanting to do analysis on it. https://cloud.google.com/bigquery/public-data https://cloud.google.com/bigquery/public-data
- inetknght 4y ago
- franga2000 4y agoWho said anything about owning it? Just making it available for processing through their platform too.
- CobrastanJorji 4y agoSometimes people do a thing where they see certain keywords in combination and reflexively respond without regard to the meaning those words are expressing. For example, it's what happens if I use a word like "welfare" near that one uncle at Thanksgiving. The signature feature is a very strong negative reaction but with content that doesn't seem related to what the previous person was saying, except that it involves certain keywords. I think that's maybe what happened here. You saw "Google," "data," and "ingest," and your sentiment analysis report came back positive, and it triggered a response.
- jimmydorry 4y agoNot GP, but if Google is the only provider hosting this data... that is not ideal.
- ecommerceguy 4y agoProviDRs Care network is hosted in Google Drive. All 200gb compressed. The article writer has probably never heard of this network. https://drive.google.com/drive/folders/1zmNEPoVCa0kIVBIu2hu7V5LtsXzbVE5L https://drive.google.com/drive/folders/1zmNEPoVCa0kIVBIu2hu7...
- thelastgallon 4y agoI wonder what their egress bill will be if a large number of people are interesting in parsing this data.
- daniel-cussen 4y agoYeah the whole SaaS breaks expectations as far as using a server.
- intrasight 4y agoSeems crazy that SEC rules require structured data but these health accounting rules did not. I guess health care has better lobbyists.
- fishtockos 4y agoAnyone knows if this dump contains drug insurance coverage?
- duffpkg 4y agoI'm author of Hacking Healthcare for O'Reilly, 20 year health system executive, blah, blah. It's very easy for people to forget the scale of the US "health system", we are talking 1/5, maybe more, of the entire US economy. If US healthcare spending were a country, it would have the third largest GDP in the world. Accidents of history and the massive federal beauracracy created the crazy monster of ICD/CPT codes that results in the very clumsy way of pricing healthcare services that results in this massive matrix of data. As pointed out elsewhere there is a tremendous amount of cost distribution that goes into the code matrix and this plays a large role in negotiations with health insurers as well. Ground is given in one set of procedures and lost in others. This is a big step in shining light into areas that need it to improve the system overall.
- e_i_pi_2 4y agoDo you consider the amount that the US spends per capita on healthcare relative to other countries for the same standard of care a "failure" of the healthcare industry? Or is there some other reason healthcare "just costs more" here? Also wondering what you think a solution is - single-payer for better and simpler price negotiations, or some other approach? My main concern is if we're spending 20% of GDP on something other countries accomplish with 10%, then that's a huge waste, especially in a country with a larger total GDP pool.
- duffpkg 4y agoHealthcare is such a base layer of the economy, I find comparisons to be extraordinaly difficult between countries. On the most basic level our pathway to becoming a healthcare provider of all sorts is dramatically more expensive and limited than other countries, what healthcare providers are paid is dramatically more than other countries, we invest many times per capita what other countries put into basic medical research, the way are population is taxed is very different than other countries, our patient population is very different from other countries, our expectations are very different from other countries, our scale is dramatically different than other countries, and so on. The US is a singular animal politically in that it is a compact of individual states that especially in regards to healthcare, the federal goverments powers (though it may not seem so at times) are actually quite limited. It's all but impossible to come up with reasonable numerators and denominators for comparison.
- e_i_pi_2 4y agoMy current assumption is that private healthcare/insurance is to blame, because countries without that or with less generally have better outcomes at less cost. Looking for evidence to the contrary
- coredog64 4y agoAs two quick examples, both Switzerland and France have private healthcare providers and insurers. I think that’s enough to falsify your assumption :)
- simonw 4y agoThose countries both have "less generally" than the USA.
- e_i_pi_2 4y agoI don't think that disproves a general trend that increased socialization in healthcare costs leads to better outcomes and less per-capita spending. Also FWIW France and Switzerland both have universal healthcare, under different systems where France splits payments 3 ways and covers more with the govt[1], and Switzerland seems to have a system like the ACA in the US where it's compulsory, but they also set caps on the deductibles and maximum price. [1]: https://en.wikipedia.org/wiki/Health_care_in_France https://en.wikipedia.org/wiki/Health_care_in_France [2]: https://en.wikipedia.org/wiki/Healthcare_in_Switzerland https://en.wikipedia.org/wiki/Healthcare_in_Switzerland
- JumpCrisscross 4y ago> France and Switzerland both have universal healthcare You said private healthcare/insurance were to blame. Switzerland has private health insurance. Universal healthcare is a separate goal post. For what it’s worth, I’m unclear its comprehensive iteration is compatible with America’s immigration model. (It absolutely is for life-saving measures.)
- PaulDavisThe1st 4y ago
- bottlepalm 4y agoThis is the real solution to healthcare costs and quality. Instead of the government handing hospitals a blank check for low quality services in a single payer scenario, we allow price transparency, competition and the free market to drive down costs and increase quality. Hate him if you want, but this was a huge accomplishment by Trump that has just started to take effect. If you think the government can bring down the cost of anything please see education and NASA for great examples.
- jcadam 4y agoYou had to know you'd be downvoted mercilessly for that, comrade.
- bottlepalm 4y agoI'm hovering at zero lol, a lot of my comments are a war between up and down voters. I wish I could see total votes.
- emkoemko 4y agoNASA?
- trts 4y agoNASA’s budget for 2022 is about $24 billion or roughly $145-$150 per working person. Perhaps a lot of money depending on what you think should be prioritized. personally I think it’s hard to argue that they aren’t delivering something of high value to humanity, especially recently with the success of the JWST. And maybe very especially compared to other agencies.
- bottlepalm 4y agoNASA is wasting the bulk of their funding in an obsolete launch system. Over the he past 50 years they have held back any economical progress in access to space. https://www.washingtonpost.com/business/nasas-artemis-rocket-is-a-gigantic-waste-of-money/2022/09/04/8b5dc4d8-2c6d-11ed-bcc6-0874b26ae296_story.html https://www.washingtonpost.com/business/nasas-artemis-rocket...
- esotericimpl 4y ago[dead]
- nimbius 4y agothis disclosure was spurned by recent federal legislation that required it. Im a full cynic on the disclosure, so be warned. - these prices, as negotiated between insurers and providers, were already well known inside the industry. so much so that many procedures could be declined coverage well in advance of a customer ever needing one. this insider knowledge formed the core of many earnings reports for insurers and hospitals alike, - Disclosure is meaningless if the customer has no alternative. most health services that bankrupt are emergency medicine, and as such youll pay anything to save your own life. thrusting a stack of price sheets at a faceless national healthcare monopoly and demanding a fair price is a laughable if not sad idea. Healthcare is not something capitalism is equipped to competently support. - hospitals have zero incentive to work with you on any price for any service, and no federal state or local law will compel them to do so by virtue of a combination of bureaucratic deadlock and regulatory capture. is it, for them, more profitable to sell your arbitrary debt to a credit collection agency? shove you into a debt counseling service they get kickbacks from? work a long and grueling payment plan through their own financial services division to bolster quarterly profit long-term in a recession? or just ignore your pleas entirely? what they charge is not up for debate by you.
- xtracto 4y agoFor profit Health insurance is a scam. It´s like if you signed a contract to pay Netflix a monthly fee to eventually watch a movie, and for some reason Netflix profit would be based on you watching as little as possible. They would do all in their power to minimize the amount of content you could really watch. Unaligned objectives. And the problem is that unlike Netflix, Health Insurance (at least in the USA) is inelastic: You MUST pay for it.
- flowersjeff 4y agoFrom my understanding though, these 'prices' are outdated nearly as quickly as they are published. I.e. sure you have a set, but everything is dynamic and changing. Seems like it would require a ML approach to 'understand' such a dataset going forward.
- MichaelZuo 4y ago6000 hospitals x say around 10000 priced items, on average, per hospital x 100 different negotiated pricing formulas = 6 trillion unique prices. Of course many hospitals negotiate en bloc as part of a healthcare network, and there probably are more than 100 different organizations that negotiated unique healthcare pricing but the ballpark number seems to make sense.
- syntaxing 4y agoA bit off tangent, is there something that can ingest unstructured data and output something meaningful? Something like GPT-3 but huge amount of data.
- throw123123123 4y agoDe-reg. De-reg. De-reg.
- jdougan 4y agoHere is a golden opportunity for the info/data visualization community to show how their tools can handle big datasets to make them comprehensible to the public.
- javajosh 4y agoThis is unacceptable. Perhaps it meets the letter of the law, but certainly not the spirit. This doesn't begin to make healthcare anything like a "free market". It's dishonest in the same way a restaurant might be forced to release a nutritional analysis of their food, and so they release a molecule-by-molecule description. Despicable.
- SnowHill9902 4y agoIs it possible that they intentionally bloated the data to make it difficult to use effectively?
- ecommerceguy 4y agoThis "data dump" is step 2 of 4 to deliver "on President Trump’s executive order on Improving Price and Quality Transparency in American Healthcare to Put Patients First."(1) By January 1, 2023, plans and issuers must make price comparison information available with respect to an initial list of 500 identified items and services. By January 1, 2024, plans and issuers must make price comparison information available with respect to all covered items and services. This information must be made available through an internet-based self-service tool and in paper form, upon request. Typically, consumers receive an Explanation of Benefits after receiving care, which details the prices charged by the provider, the plan’s contracted or negotiated rates, consumer cost-sharing obligations, and other information. Consumers will have access to this type of information before receiving care and can use it to compare prices and better estimate potential out-of-pocket costs.(2) (1)https://www.cms.gov/newsroom/fact-sheets/transparency-coverage-final-rule-fact-sheet-cms-9915-f https://www.cms.gov/newsroom/fact-sheets/transparency-covera... (2)https://www.cms.gov/healthplan-price-transparency/consumers https://www.cms.gov/healthplan-price-transparency/consumers
- sbf501 4y agoI don't understand why this took so long when it was part of the ACA in 2014 [1]. How did it take another administration, an executive order, and 8 more years?! Hell, even the Clinton plan was calling for it in 1993 [2] but that never went anywhere. [1] https://www.healthleadersmedia.com/finance/new-price-transparency-rules-hospitals-under-obamacare https://www.healthleadersmedia.com/finance/new-price-transpa... [2] https://www.heritage.org/health-care-reform/report/guide-the-clinton-health-plan https://www.heritage.org/health-care-reform/report/guide-the...
- ThaDood 4y agoI think the reasons are just that: an administration change, fumbling about, lawsuits (if any) among other things. One specific reason appears to be that some hospitals were able to file waivers apply for exceptions. [1]. Not that I agree with any of these reason. [1]https://www.cms.gov/files/document/hospital-price-transparency-frequently-asked-questions.pdf https://www.cms.gov/files/document/hospital-price-transparen...
- Beefin 4y agoI started a healthcare cost transparency platform in 2014 [1] and struggled to find costs by CPT code. The best we had was medicare reimbursement rates, which were hardly a good litmus for out of pocket costs. It's nice that after 8 years, things are finally shifting. Just shows how important timing is in entrepreneurship. [1] https://ethansteininger.com/portfolio/comparedcare https://ethansteininger.com/portfolio/comparedcare
- soheil 4y agoFYI, if you want to view the data in a reasonable format replace ~ with comma, but first make sure to replace any commas with something like a semicolon. I guess csv delimiters can be anything and they chose ~! Good thing there are no insurance company names with a ~ in it.
- BryLuc 4y ago
- seaourfreed 4y agoUSA Healthcare is 19.5% of GDP. Canada + Australia + UK + (a few similar countries) average 10.5% of GDP. The USA healthcare price gouges via run away prices. Healthcare corporations corrupting congress is the fuel that forces this on people (and breaks a free market).
- chii 4y agoBut looking from another perspective - if healthcare is 20% of GDP, an awful amount of people are therefore paid directly due to this "waste". Any improvement in efficiency would mean those people lose out on jobs. A new use for them must be found, or there will be massive unemployment (at least, short-medium term).
- Invictus0 4y agoYes, and we should also think of the blacksmiths and the elevator operators, milkmen and horse carriage drivers, who will unfortunately be out of a job if we make our society more efficient.
- cuteboy19 4y agoWhy not go further still. Smash a window so that window makers can make a living, slash someone's tires so that tire companies can employ more people.
- RoadieRoller 4y agoIndia is considered a "cheap and poor" country in many ways. It's GDP is 1/10th that of United States. Even then, India has free health care, and in many states (out of the 30+ states), Govt run healthcare is the best. Woman give birth to babies and walk out paying almost nothing, men break their bones and walk out paying nothing after a month of staying in hospitals and such. Insurance is never heard of or forced to, unless you own a automobile and pays insurance to drive it on roads. No monopoly of any kind. And there are arguments against all these points, I concur. I just said it for the American folks to know.
- aneeshnl 4y agoEven private providers are affordable.
- mwerd 4y agoMust be fairly recent then...cause 10 years ago it was poor quality care by untrained staff. https://www.mhtf.org/2017/06/23/quality-of-routine-labor-and-delivery-care-in-uttar-pradesh-india-are-private-facilities-better/ https://www.mhtf.org/2017/06/23/quality-of-routine-labor-and...
- zxexz 4y agoHuh. 8 or 9 years ago I visited somebody in a hospital in rural India (maybe 100km from Hubli), and this was definitely not the case. A man was being ejected (after intake!) from the hospital with acute appendicitis because he and his family was unable to pay. There were probably 3 nurses in the hospital and 40 patients over several floors. The degraded ductwork and disgusting window mount aircon looked like legionnaires disease would kill anybody who could afford to stay. Has a lot changed in the last decade? Is the “good” healthcare just in wealthier areas? Was this just an extreme outlier? Obviously, this is just one (anec)datapoint.
- Xx25 4y agoNominal GDP is not the best way to compare countries in these matters. Purchasing power parity might be a better metric as we are talking about service Indians can get in their own country.
- juanani 4y ago
- godmode2019 4y agoI believe this was a Trump policy
- xdmr 4y agoTo save anyone else similarly curious the trouble, here's a sample record from the Humana data set: {'REPORTING_ENTITY_NAME': 'Humana Inc', 'REPORTING_ENTITY_TYPE': 'Health Insurance Issuer', 'LAST_UPDATED_ON': '2022-08-24', 'VERSION': '1.0.0', 'NPI': '1629053517,1659354272', 'TIN': '593279318', 'TYPE': 'ein', 'NEGOTIATION_ARRANGEMENT': 'ffs', 'NAME': 'Nasal Prosthesis Replacement See Also Code 21087', 'BILLING_CODE_TYPE': 'CDT', 'BILLING_CODE_TYPE_VERSION': '2022', 'BILLING_CODE': 'D5926', 'DESCRIPTION': 'Nasal Prosthesis Replacement See Also Code 21087', 'NEGOTIATED_TYPE': 'negotiated', 'NEGOTIATED_RATE': '906.98', 'EXPIRATION_DATE': '9999-12-31', 'SERVICE_CODE': '', 'BILLING_CLASS': 'professional', 'BILLING_CODE_MODIFIER': '', 'ADDITIONAL_INFO': '', 'BUNDLED_BILLING_CODE_TYPE': '', 'BUNDLED_BILLING_CODE_VERSION': '', 'BUNDLED_BILLING_CODE': '', 'BUNDLED_DESCRIPTION': ''} I think I agree about the negotiation arrangement
- xdmr 4y agoFor comparison, here's the first bit of an Anthem file (which contains some of the data that's just another row in the Humana record), along with the first record "reporting_entity_name": "Excellus BlueCross BlueShield", "reporting_entity_type": "Health Insurance Issuer", "last_updated_on": "2022-06-14", "version": "1.0.0", "provider_references": [ { "provider_group_id": 302.1518360704, "location": "https://mrf.healthsparq.com/exc-egress.nophi.kyruushsq.com/prd/mrf/EXC_I/EXC/providerReference/Providers/S-000000001063.json" } ], "in_network": [ { "negotiation_arrangement": "ffs", "name": "Brief (20 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a benefi", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0081", "description": "Brief (20 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a benefi", "negotiated_rates": [ { "negotiated_prices": [ { "negotiated_type": "fee schedule", "negotiated_rate": 51.1, "expiration_date": "9999-12-31", "service_code": [ "11" ], "billing_class": "professional" } ], "provider_references": [ 302.1518360704 ] } ] },
- spaghettiToy 4y agoNothing enrages me like US healthcare. Physicians have a monopoly on treatment and restrict supply through the ACGME. Hospitals and physicians have spent 1Billion on lobbying. I could go on, I want a science based healthcare as an alternative to our authority based system. It would be one thing if our system healed everyone, but the number of mistakes is enough to make me lose faith completely.
- iamcrazyyounus 4y agoThe issue is that states are largely arbitrary historical accidents. You'll need this for a variety of things. "Vice" states are located next to more conservative states. Consider the states of New Hampshire, Delaware, Pennsylvania, and South Carolina. In the case of healthcare, states have a tendency to shift costs elsewhere. As in, send the sick person to New York City.
- Xx25 4y agoWhat happens if we mandate that hospitals cannot charge patients more than the lowest negotiated price they have for any procedure? That is to say, if you have offered to perform a procedure for $X, you can not charge anyone more than $X for the same procedure.
- supermatt 4y agoThis is clearly obfuscation. There is no way they have "negotiated" half a trillion of anything.
- pixel_tracing 4y agoI wonder if our entire health care problems in the US stem from the medical cartel itself. You have medical schools limiting seats, you have physicians and head physicians and medical groups lobbying for changes, and you have inflated doctor salaries… A sane approach might be to let more people graduate medical school and increase the number of applicants…
- Silverback_VII 4y agoI know that most people don't like to think twice when it's about their own health but as a society we have to ask if it's ethical to heavily indebt or tax the young working age population to extend the lives of a few old peoples who often never regain their full health. In the actual system good lifetime is traded for bad one.
- dsq 4y agoA common complaint here is that the single payer systems / public run systems have very long wait times compared to private US systems (this is true where I live as well. A simple MRI is a five month wait and that requires traveling to a different city).
- rapht 4y agoAren't the costs of the US healthcare system largely driven by the cost of the healthcare workforce - basically, not enough trained personnel leading to the absence of competition, leading to doctors getting paid much more than they should? Of course it's going to be more complicated, with doctors' insurance issues and the price of meds into the mix, but still, how far does this factor goes into explaining the extraordinary cost of getting a basic treatment (let alone surgery) in the US?
- JAA1337 4y agoA worthy cause. Thank you so much for your work. Please keep it up.
- aquaphile 4y agoI'm the CEO and cofounder of a health insurer that published its pricing data. See it on GitHub at https://github.com/evryhealth/price-transparency https://github.com/evryhealth/price-transparency To add some fuel to this discussion, US healthcare has grown 3x as a percentage of GDP in 60 years from approx. 5% to more than 15% [1]. It has done so at the expense of the rest of the economy and communities. Pricing transparency is only one piece of the puzzle. It is a tremendously antiquated industry. Fax is still state of the art -- welcome to the 1980s! [1] CMS. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...
- foobarbecue 4y agoI don't think he meant largesse did he? He seems to mean "large size."