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Open-source hospital price transparency
- atourgates 4y agoThis seems very cool. But, at the risk of seeming extra dumb: is there a way to contribute to this project for people who don't know how to work with SQL?
- tomrod 4y agoI've seen dolthub's work progress in this space from afar -- they are solving a hard problem! One of the most frustrating things is that insurance companies seem to push for strategic bitrot, making it difficult to programmatically or frequently collect the information from a large group of payors.
- htrp 4y agoobtuse data pipelines are a strategy..... if the government forces you to make something available, it doesn't necessarily have to be easy to get
- zachmu 4y agoSure, SQL knowledge is helpful but optional. There are ways to import CSV or other flat files, either on the command line or on dolthub. You just need to make your file's schema match the table's.
- einpoklum 4y agoWhile I'm sure the transparency is a good idea, I'm guessing is only important because US hospitals mostly charge individuals rather than health insurance providers / healthcare provider organizations ("sick funds") - and thus people are surprised by exorbitant fees and hospitals have a motivation to overcharge, rather than the fees being negotiated and agreed in bulk.
- manv1 4y agoA discussion of healthcare pricing would take hours, but here's a TL;DR: Most insurers pay negotiated rates, which have no real relationship to list price (uninsured pricing). The law is supposed to (1) make it easier to compare costs, and (2) shame providers into lowering their list prices. Obviously the industry has been fighting these regulations for years. The annoying thing is al the games they're playing. Everyone already has a list of prices by CPT code, because it's what billing uses. Just list all prices by CPT codes. The industry refuses.
- einpoklum 4y agoAnd IIRC, the insurers are for-profit, right? What about the hospitals? Are they mostly for-profit or non-profit entities?
- deleted 4y ago[deleted]
- lotsofpulp 4y ago>I'm guessing is only important because US hospitals mostly charge individuals rather than health insurance providers / healthcare provider organizations ("sick funds") No, they charge the insurance, but US healthcare providers are still required to show individuals the billing details. This is important because people still pay for amounts up to their deductible and out of pocket maximum, so for non emergency healthcare, a patient still has incentive to compare healthcare prices from different providers.
- einpoklum 4y ago> This is important because people still pay for amounts up to their deductible and out of pocket maximum In many world states, if you have health insurance, and are referred to hospitalization, or come in with a wound or other obviously serious condition, your deductible/out-of-pocket for being in the hospital is exactly 0. Israel is in this category for example. This doesn't cover 100% of hospitals but all the big ones and your "sick fund"'s hospital-grade facilities. In other countries (e.g. the Netherlands), a lot of health care expenses are charged through to you from the get-go, but - your annual out-of-pocket maximum is low, e.g. 500 EUR or 700 EUR or something like that (EUR ~= 1.05 USD right now, was higher when I was in the Netherlands). So, you might be interested in what hospitals charge, but it's not like you would save all that much anyway.
- soitgoes511 4y agoI hope this succeeds. My daughter was born with many medical issues and understanding the billing was always near impossible. Nothing could be gleaned from the bills which would arrive 6 months to a year later (sometimes 2 years) from the insurance company. In what world can I not know the price of something before hand? If I go to a restaurant and see hamburgers cost 6000$, I wouldn't buy one. But with medical it is always a surprise.
- tyingq 4y agoAgreed, it's a huge mess. Often, you are also not always told when something is even a billable item at all. You can find examples of itemized bills including things like band-aids at crazy inflated prices.
- yamtaddle 4y agoI've received bills from entities halfway across the country with no fucking clue what role they actually played in care. It's completely fucked. No other industry gets away with billing this messed-up and sloppy. And I'm 100% sure some of the errors are "accidentally on purpose".
- diob 4y agoWe also need to start acknowledging most medical care is urgent and not a choice. Happy to see some movement on at least price transparency though.
- bumby 4y agoThis is cool and, I believe, a necessary step. I know that some hospital price data has been previously available for years on govt websites listed by billing code. You could, for example, see the price differential between getting a procedure done in Alabama vs. Oregon. This article states that hospital data was only available after 2019. Is the distinction that the previous data was only based on Medicare/Medicaid reimbursements? Or that they weren't itemized lists?
- wswope 4y agoSounds like you’re talking about Medicare rates. A lot of hospitals and payors use them as the basis for their price lists, but unless you’re an actual Medicare patient it’s probably not what you’re actually paying. This data is collected from hospital “chargemasters” - which lay out the maximum amount a hospital will charge for a given procedure. However, hospitals have negotiated rates with payors that are almost always less than the chargemaster rate and are kept private. As a broad generalization, you can think of Medicare prices as the minimum a hospital will normally charge, and the chargemaster rate as a legally-enforced maximum.
- hunterb123 4y agoWon't work until the current administration enforces the law. Hospitals are defying it and not posting prices with no repercussions.
- atourgates 4y agoDid you read the article? > In the three years since, disclosure of these price lists has been hit and miss. Some hospitals posted partial price lists, others none at all. (They were probably counting on not getting caught.) Two hospitals fined over $1M combined in 2021 for refusing to host these files (but since the penalty, have since taken a U-turn and published their prices.) This might have been to send a message to the other hospitals to get serious.
- hunterb123 4y agoYes I did. Two hospitals being fined nearly two years ago != enforcing all hospitals posting full price lists. You don't just "send a message" once, you fine hospitals not compliant, period. We do this for other regulations. So at this rate maybe in 2040 most hospitals will post their prices, maybe. If everyone feels like following / enforcing the law. Also, did you read the guidelines? > Please don't comment on whether someone read an article.
- sl-dolt 4y agoI'm the author. The CMS has done a lot since then, including beginning to enforce their Transparency in Coverage act, which is even more comprehensive than the Transparency in Pricing act (which is what this article is about.) See the article I wrote on this last month: https://www.dolthub.com/blog/2022-09-02-a-trillion-prices/ https://www.dolthub.com/blog/2022-09-02-a-trillion-prices/
- danesparza 4y agoI'm confused. Is this already a searchable database? Or is this in the 'data gathering' phase?
- culi 4y agoSeems like this is the actual db, but the only table I see is "hospitols" which just has the websites and... a link to `cdm_source` which seems to be the pricing info for each hospital Not sure what they mean by "bounty" > This bounty will be run in 5 parts of 1 week each Is this some sort of crowd-sourced effort? Like GasBuddy but for hospitals? Their GitHub also some "example" apps with React, Lit, and Next https://github.com/onefact/payless.health/tree/main/examples https://github.com/onefact/payless.health/tree/main/examples I guess I should try building one of these examples first
- culi 4y agoFunny that they obviously have the resources for making example apps in multiple frameworks but all their main websites are just the MarkDoc template with different text haha
- sl-dolt 4y agoI'm the author (Alec.) This is the data gathering phase. When we're able to release a database of these hospital prices with high data quality I think it'll be a pretty big deal, just because it's so much work. It's hard as hell because of how inconsistently formatted these price sheets are. We'll need to develop a robust ML tool to process all of them in a consistent way, or just put a lot of man hours in. That's something that One Fact is working on. DoltHub's main interest is in producing the source databases, which is just a lot of grind work. We're crowd sourcing the data collection via a "data bounty." It's like a scavenger hunt where you get paid for the data you input. I designed the table and I'm who reviews the data going in, via pull requests. Incidentally we do have a hospital price database here (the only open one of its kind) but with mixed data quality. https://www.dolthub.com/repositories/dolthub/hospital-price-transparency-v3 https://www.dolthub.com/repositories/dolthub/hospital-price-...
- EamonnMR 4y agoI really wanted to build something like this but never found the time. The challenge was ETL-ing all of the data provided by hospitals.
- sl-dolt 4y agoI'm the author. That's right. At least, starting from our database, you won't have to do the hard work of tracking down each of these 5000+ URLs.
- ww520 4y agoThis is amazing work. All hospital pricing should be public and transparent.
- hahamrfunnyguy 4y agoThank you for doing this. It's good to know that this information is publicly available. I was not aware of the 2019 legislation and it would be helpful to know what the name of the law is. I went to urgent care back in 2021 to have a few different tests run, pretty standard stuff. I asked for a price quote and they refused to give it to me. There is no other industry where sleazy practices like this are accepted.
- insane_dreamer 4y agoImportant work. Thanks to those working on this.
- ElijahLynn 4y agoDirect link to the hospital price database > https://www.dolthub.com/repositories/onefact/paylesshealth https://www.dolthub.com/repositories/onefact/paylesshealth
- timsehn 4y agoThis is just a database of hospital price URLs. If you want actual prices we have that as well but it's from the beginning of the year: https://www.dolthub.com/repositories/dolthub/hospital-price-transparency-v3 https://www.dolthub.com/repositories/dolthub/hospital-price-...
- ryanfreeborn 4y agoTangentially related, Russ Roberts of econtalk had a good interview a few years ago with the founder of a free market hospital in Oklahoma. Super interesting. https://www.econtalk.org/keith-smith-on-free-market-health-care/ https://www.econtalk.org/keith-smith-on-free-market-health-c...
- prepend 4y agoI think of this every time I encounter a healthcare worker who talks about how it’s “impossible” to estimate and brings out some edge case of a routine $50k procedure costing $500k with complications and leaving out the part how there are many instances where it only costs $25k. It’s like hospitals pretend to be idiots when other industries can estimate a median cost and price accordingly. And they have estimates good enough to be profitable. Even barbers charge $30 for a haircut when some take 5 minutes and some take 30. If a barber didn’t post prices because it’s impossible to estimate how many minutes it takes to cut hair I wouldn’t use them unless my life depended on it.
- refurb 4y agoIt's much easier to offer estimates for specialist clinics. In hospitals? The honest answer is they often don't know the true costs. They'll know the costs specific to a department, but the "shared" costs of the hospital, staff (who work across departments), etc are a major shit show. That's not to say they can't find out, but it's not easy and frankly they don't do it because they don't have to.
- prepend 4y agoThey don’t need to know the true cost. They just need to estimate well enough to break even. They do tens of thousands of procedures each year. The podcast goes into this concept and their hospital isn’t a specialist clinic, they do everything a hospital typically does.
- SkyPuncher 4y agoThey don't know the true cost for the full stay, but they certainly know the likely daily cost.
- killjoywashere 4y agoThis law was insanely helpful for my wife as she tried to establish pricing for her own small business. Going from a drone to your own boss, it's hard to wrap your head around how much more you should be charging. It's a lot. Like, multiples.
- duffpkg 4y agoI wrote Hacking Healthcare for O'Reilly and I've spent the bulk of my career as a CEO and senior executive operating large health systems. It is a meaningful step forward to have most of this data in the public sphere but I think it is still early and that a lot of work has to continue to shape and analyze this information in a way that is more meaningful and practical for patients. Appreciate the complexity of billing codes, these are not created by hospitals but by by the American Medical Association, Center for Medicaid/Medicare and a soup of other organizations. There are tens of thousands of procedure and drug codes (things that are done or given) and tens of thousands of diagnostic codes (reasons justifying the procedure), creating a space well into the quadrillions of possible routine combinations. That's a large restaurant menu. There are a number of other comments comparing hospital pricing to retail type interactions. It is also important to consider that hospital interactions involve unexpected and unknown things that aren't easily captured in a pricing context before you get there. From an instution standpoint there are some bad apples but a lot of organizations that are not complying are not complying because they are facing technology and operational issues that are stopping them from complying. From the trenches in my consulting practice one example is an institution whose has a core element of their billing system, that is largely a black box even to them, using technologies that are decades old. Why would someone continue to rely on that? Because it has direct integration with critical partners and counterparties that was set up decades ago and that continues to work. Replacing it is underway but is costing 8 figures and taking years. The potential fines are small relative to that and there isn't much they can do to comply in the immediate term anyway. For context understand that Medicare billing routinely involved actual physical dial-up modems somewhere in the chain (even if it was invisible to you) until late 2018.
- senortumnus 4y agoOne benefit of this transparency initiative is that patients will come to see how little of their bill goes to physicians.
- paws 4y agoThanks for sharing! Billing codes certainly seem like a significant source of complexity. Another area that seems problematic to me is an apparent surfeit of middlemen. What conclusions might we draw from the fact e.g. a "Pharmacy Benefit Manager" is a job that exists only in the US [0]? Why does it feel like my insurance premiums pay for lots of things that are difficult to attribute to actual improved health outcomes? Appreciate your insight. [0] https://www.goerie.com/story/opinion/2021/06/12/op-ed-when-comes-prescription-drugs-pbms-have-power/7617580002/ https://www.goerie.com/story/opinion/2021/06/12/op-ed-when-c...
- tapatio 4y agoHow were you able to do this if billing codes are copyrighted? Where did you get all of the billing codes? Also, isn't this pointless as the final pricing is highly dependent upon one's insurance policy? Also, the price differs if you pay cash versus with insurance.
- shmerl 4y agoI'd guess factual information can't be copyrighted, it's not a creative work.
- tapatio 4y agoThe American Medical Association copyrighted it. I didn't know factual information can't be copyrighted. The "copyright" text on their website is rubbish then. Learn something new everyday. Thanks!
- shmerl 4y agoI think simply a collection of facts can't be copyrighted. It must have some kind of creative added value for copyright to be applicable, like an encyclopedia presenting these facts may be would be an example. And yeah, it's not uncommon for some to slap "copyrighted" on something where it's not applicable.
- sl-dolt 4y agoI'm the author of the article, but I'm not a lawyer. Regarding your first point: I'm aware of the copyright on billing codes. I suspect it means "you can't make your own billing codes based off of our system." I don't think it means you can't republish the codes anywhere. They're republished all the time. Someone can jump in and correct me. Secondly: The CMS law required hospitals to itemize their procedures by billing code _and_ by insurance company. Not that they all do that, but in theory, these negotiated rates should allow you to price shop between hospitals. The "list prices" are effectively meaningless.
- raiyu 4y agoThe reality of is that for profit insurance companies want an opaque and high pricing structure. This allows them to charge higher premiums across their entire set of customers meanwhile the number of people that are getting seriously sick or injured is small allowing them to create huge profits. So these higher prices, create higher premiums, which create higher profit, so there is no actual incentive for the insurance companies to get hospital prices down because the majority of their insured users are not going to be getting massive bills throughout the year and also they can still litigate or pass healthcare costs back to the customer due to coverage issues and let's not forget deductibles.
- NickC25 4y agoThis! And not only are they for-profit, they're public companies, too! Companies that are required to increase revenues, make more money each quarter, etc. Imagine the long-term cost savings to the consumers if massive insurance companies were banned from lobbying or "influencing" lawmakers.
- supernova87a 4y agoJust like the problems with pay transparency / publishing in job listings, what good is the publishing of hospital costs, if they inflate the rack rate prices to handle people who walk in without insurance, but discount everyone else to the Medicare rates? It doesn't give you any real comparable reference point between hospitals, does it? As an example, you get a bill for $100k for a one-night hospital visit for an emergency, but it gets knocked down to $15,000 at Medicare reimbursement rates, and then you only pay $1,000. Which price should be shown? It is any use to show the $100k figure? Or am I missing something that has changed? I mean, I'm all for these efforts but if there is no consistency / meaning behind the numbers being used, it's no good.
- jaan 4y agoYou're right! We're linking this data to the negiotated rates :) and building the search engine for both of these at payless.health.
- supernova87a 4y agoThank you!
- rjh29 4y agoEh? So even with insurance you pay $1000 for one night in hospital in the US? Or are you just making up an example figure here.
- sl-dolt 4y agoI'm the author of the article. The inflated price you're talking about is called the "gross price." It's a made-up price, or MSRP. Just publishing this price list isn't that helpful. The price lists are supposed to contain the negotiated rates with different insurance companies or medicare. Those reflect the rates that your insurance company pays. You pay some fraction of that depending on your plan. Most price lists don't contain this information, though. The purpose of the article was to see how many of them contain the elements that are required from the transparency bill, the ones which allow meaningful price comparison between hospitals. And the answer is... not that many do. But among the ones that do, you can kinda sorta make a meaningful comparison (but there are even caveats there as well.) Feel free to follow up if you have more questions.
- jrd259 4y agoNow what is needed to get data on outcomes as well? I would likely choose to pay more for a increased chance of success. (Recall the recent coverage in HN of the professional musician for whom retaining ability to play saxophone was of great importance.) I recognize that some hospitals either serve more impaired populations or take on more high risk cases, so the comparison is not at all easy.
- jaan 4y agoYes! We are working on this and integrating with the OMOP common data model, to be able to link the health outcomes in our data partners' clinical repositories to the cost of care. For example, we work with the NIH All of Us study for outcome data (joinallofus.org -- I signed up both to contribute to this science and to get my whole genome sequenced free!)
- TedDoesntTalk 4y agoWhy is AI necessarily for this? > One Fact to feed these files into their artificial intelligence pipeline and figure out how much hospitals charge for different procedures
- culi 4y agoIt seems like their database[0] has a column for the `cdm_url` of all of these hospitals. The challenge is like being able to read all these HTML, PDF, XLXS, CSV, etc pages of very different formats and turn them into usable data Just my guess [0] https://www.dolthub.com/repositories/onefact/paylesshealth/data/main https://www.dolthub.com/repositories/onefact/paylesshealth/d...
- jaan 4y agoNailed it! :)
- jaan 4y agoIf you look at the files, many of them are not compliant, and so we need to figure out what the associated line item corresponds to: a CPT code? HCPCS code? ICD code? etc :) Here's an example NLP tool I helped build we're using to do this: https://arxiv.org/abs/1904.05342 https://arxiv.org/abs/1904.05342 -- it's in several pipelines now for data annotation and crowdsourcing.
- deleted 4y ago[deleted]
- jordanmorgan10 4y agoMy first job out of college was creating long term facility software, like Epic if you're familiar with that world. After my second or third major project to support ICD-10 codes, I knew this was an industry I really didn't want to create software for, but also that it was an industry that definitely could use some quality solutions.
- erex78 4y ago"it was an industry that definitely could use some quality solutions." >> Check us out! augusthealth.com
- car 4y agoI would suggest to now compare the prices for standard procedures in the US to the GOÄ[0,1], which is the German central medical fee list for anything medical as agreed between doctors and insurance companies. Hilarity will ensue, since US pricing is an unbelievable rip-off. Edit: In addition to procedures, there is a list for fixed drug cost [2]. The site hosts a PDF with pricing for any drug. [0]https://de.wikipedia.org/wiki/Gebührenordnung_für_Ärzte https://de.wikipedia.org/wiki/Gebührenordnung_für_Ärzte [1]https://www.ottonova.de/en/expat-guide/health-wiki/medical-fee-schedule-goae https://www.ottonova.de/en/expat-guide/health-wiki/medical-f... [2]https://www.bfarm.de/EN/Medicinal-products/Information-on-medicinal-products/Reference-Pricing/_node.html https://www.bfarm.de/EN/Medicinal-products/Information-on-me...
- kingsloi 4y agoGreat idea! I'm working on something similar, digitising my daughter's 213 pages of medical bills by building an app specifically for digitising printed medical bills. https://kingsley.sh/posts/2022/digitising-213-pages-of-medical-bills https://kingsley.sh/posts/2022/digitising-213-pages-of-medic... Everyone kept saying "make sure to check your statements", but when the statements came, they're 9pt font, 50-70 line items per page. 1 page, yes, 10, maybe, 213 is impossible. In the middle of working on it last week, I got a $3000 medical bill, for my daughter who passed away 1.5+ years ago, for part of her 7 month ICU stay 2+ years ago.
- camdenlock 4y agoIt sounds like a lot of people are encouraged by this work. I’m taken aback by the name, though. I looked around their site and couldn’t find an explanation.
- culi 4y agoIs it possible you've already been beat to the punch here? Seems this site actually has pricing data: https://www.ahd.com/free_profile/010001/Southeast_Health_Medical_Center/Dothan/Alabama/ https://www.ahd.com/free_profile/010001/Southeast_Health_Med...
- sl-dolt 4y agoI'm the author. The CMS law relates to specific pricing data, where each billing code is itemized, and prices are given down to the insurer level. These prices have only been available since Jan 1, 2021. Aggregate data (or "list prices", MSRPs) have been available in some cases for a while now, depending on the state and context.
- gzer0 4y agoI hope this succeeds. A single MRI can take up to 200 gb of storage space. The health system has about 7.5 petabytes of data in storage arrays alone, all of which is active and separate from backups. About one petabyte of that data is unstructured (which includes MRIs and other imaging data), and that’s the type of data that’s growing quickest. This is being done on purpose to obfuscate the pricing scheme. A shame on the industry. I have hope that, together, we can succeed and crack this. [1] https://www.itprotoday.com/file-storage-and-block-storage/how-healthcare-giant-uses-data-storage-tiers-pbs-data https://www.itprotoday.com/file-storage-and-block-storage/ho... * not sure how reliable this one source is, there isn't much information out there to verify against.
- jschveibinz 4y agoThis may be the single most valuable project I’ve ever seen posted on HN. Thank you!
- neycoda 4y agoHow 'bout somebody make a database of hospital bill charges... so we can all see what's actually being charged.
- frobozz 4y ago"Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community"
- SteveSmith16384 4y agoAs a citizen of a country that has free-at-the-point-of-use healthcare, all this talk of billing codes etc... just sounds like another expensive and complex system to try and alleviate the current expensive and complex system.
- chiefalchemist 4y agoI've gotten hospital bills and other medical bills with a date and a dollar amount, but never to details. With all the other health care regulations, how is that legal? The system favors the insurance companies and the healthcare providers, but puts its thumb on the scale for anyone else. And that system is slow to change for exactly that reason. That is, the status quo is quite happy printing money. Anyone else? Not so happy. If only health care was about health and care.