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It might exist soon. There are a few other companies working with the hospital (and much larger payer/insurer) price data, but it's a _very_ small community. It

It might exist soon. There are a few other companies working with the hospital (and much larger payer/insurer) price data, but it's a _very_ small community. It's been said that you need a screw loose to really enjoy digging into the data. Even beyond just collecting and organizing the disparate files (which Alec has been doing a yeoman's job of with an all-volunteer force), you quickly realize that many of the quoted prices are just flat out wrong, or, at best, misleading. Even people in the business struggle to make sense of them. An example: you look at a hospital MRF to see the cost for a knee surgery on a BCBS plan and it just happens to be exactly 3.5x the Medicare rate. Then you look at all their other quoted prices in the MRF and realize they're _all_ 3.5x Medicare. Someone in the billing department was really lazy putting together that MRF! Then you look at the BCBS MRF and see a rate which is 1x Medicare. Definitely not right. So you ask the BCBS affiliate what gives and they say the hospital you're looking at is on the ancient APC billing codes which means the HCPCS code you were looking at for the knee surgery would never be billed by this hospital and all the rates you just looked at are complete bunk. Now, take that knowledge and make a simple-to-use, mostly correct user-facing website! Because if you quote the wrong $ amount, the internet will roast you alive. As I said, it might exist sometime in the next few years, but it will take a lot of behind the scenes effort to make it work. Some of the folks working on this problem: https://turquoise.health/ https://turquoise.health/ https://www.serifhealth.com/ https://www.serifhealth.com/ https://tynbil.com/ https://tynbil.com/ https://www.healthcostlabs.com/ https://www.healthcostlabs.com/

atourgates 3y ago
This is absolutely right. And to complicate things even more: the hospital might actually bill 3.5x the Medicare rate to BCBS, but they’ll then expect to get paid some totally different number that they’ve negotiated separately with BCBS that’s somewhere between Medicare’s allowable and the ludicrous 3.5x they bill.
- brendanyounger 3y ago
  Supposedly all these new laws around price transparency are aimed at exposing the "real" rate, not the inflated rate on the initial bill. 3.5x Medicare is actually somewhere around "reasonable" and is what a commercial plan like BCBS will actually pay. 10x to 50x is what would appear on the initial bill. It's hard to escape the conclusion that the whole thing is a massive protection racket (i.e. pay monthly premiums or get a shockingly large bill weeks after the fact that you have no way of negotiating down except making kissy faces to the billing clerk). The only reason it hasn't been litigated on those grounds is that there are too many entities involved so whomever you prosecute first will cry foul and blame the other guy.
baishtar 3y ago
You’re not wrong! I for one am very excited about the potential benefits these Transparency in Coverage have for patients. Just the ability to shop the best rates for common procedures can save thousands per year for some. Sadly, I’ve noticed most businesses utilizing this price transparency data are primarily selling to hospitals/providers so they can negotiate better contracted rates with insurance plans.
- brendanyounger 3y ago
  You're right, and I'm one of them (tynbil.com). Problem is, that's where the money is right now and those are the only customers willing to put up with slightly wrong data. On the optimistic side, what will happen sooner rather than later is that most billing codes will converge to an average market rate. Right now, there's no invisible hand guiding reimbursement rates because no one knows what anyone else is getting. Once a market rate is established, it'll be easier to compare providers. Provider A will be 15% less across the board than Provider B, but might have younger docs or lower quality scores.

atourgates 3y ago

This is absolutely right. And to complicate things even more: the hospital might actually bill 3.5x the Medicare rate to BCBS, but they’ll then expect to get paid some totally different number that they’ve negotiated separately with BCBS that’s somewhere between Medicare’s allowable and the ludicrous 3.5x they bill.

brendanyounger 3y ago
Supposedly all these new laws around price transparency are aimed at exposing the "real" rate, not the inflated rate on the initial bill. 3.5x Medicare is actually somewhere around "reasonable" and is what a commercial plan like BCBS will actually pay. 10x to 50x is what would appear on the initial bill. It's hard to escape the conclusion that the whole thing is a massive protection racket (i.e. pay monthly premiums or get a shockingly large bill weeks after the fact that you have no way of negotiating down except making kissy faces to the billing clerk). The only reason it hasn't been litigated on those grounds is that there are too many entities involved so whomever you prosecute first will cry foul and blame the other guy.

baishtar 3y ago

You’re not wrong! I for one am very excited about the potential benefits these Transparency in Coverage have for patients. Just the ability to shop the best rates for common procedures can save thousands per year for some. Sadly, I’ve noticed most businesses utilizing this price transparency data are primarily selling to hospitals/providers so they can negotiate better contracted rates with insurance plans.

brendanyounger 3y ago
You're right, and I'm one of them (tynbil.com). Problem is, that's where the money is right now and those are the only customers willing to put up with slightly wrong data. On the optimistic side, what will happen sooner rather than later is that most billing codes will converge to an average market rate. Right now, there's no invisible hand guiding reimbursement rates because no one knows what anyone else is getting. Once a market rate is established, it'll be easier to compare providers. Provider A will be 15% less across the board than Provider B, but might have younger docs or lower quality scores.