6 ms·

I don't get how a cardiac stress test can cost 2000USD. You put someone on a home trainer, let them pedal for 20 minutes, and look at their EKG. It's usually pe

by jakobe 13y ago

I don't get how a cardiac stress test can cost 2000USD. You put someone on a home trainer, let them pedal for 20 minutes, and look at their EKG. It's usually performed by a nurse, and the doctor spends 30 seconds looking at the EKG (the analysis of the EKG is even partially automated). If there was actual competition on the market, I'm sure a health service provider would find a way to perform the test for 75USD.

haldujai 13y ago
People who have stress tests administered often have underlying cardiac or pulmonary disorders that can be aggravated. A not insignificant subset of people doing stress tests can enter into hypotensive shock or even cardiac arrest, the facility has to be prepared to deal with adverse effects as those reactions can be fatal.
- lostlogin 13y ago
  Yes - it pays to have a big defib (not one of the 'press button now' mall variety), an experienced and qualified staff member or 5 with high level CPR training, and some good cardiac event type drugs, and a load of proper monitoring gear (heart rate, BP, etc). While these things aren't especially cheap, they would pay off fairly quickly at a decent clinic, and I was involved in the purchase of most this stuff for sub $10k US recently for a clinic (but got a mall style defib as our needs are different). Staff would be the greatest cost. That said, at 2k per test, most expenses for the year would be paid of in the first week or 3 at a busy clinic surely?
  - haldujai 13y ago
    $2000 isn't that ridiculous depending on the circumstances, but $75 is impossibly low with America's system. In Canada they bill ~$200 +/- 100 depending on the details. A comparable figure in the states (again factoring insurance non-payment issues and convenience factors, i.e. how soon you can get it, having facilities close by) would be reasonable at $800-$1500.
    - vacri 13y ago
      $2000 is utterly ridiculous for a stress test. I used to work as a neurology tech, mostly dealing with epilepsy. Our tests themselves could invoke seizures, and we frequently saw seizures anyway, which can be life threatening if not handled. We were a private department in a hospital - as techs, we knew enough first aid to keep the person alive and call for the crash cart. $2000 might sound reasonable if every single patient required emergency attention, but in truth, far from it. Medical tests aren't meant to bring you to the brink of death, and are generally designed to keep you safe. It's not even worth pretending that $2k 'might' be worth it; it's just not. As for covering for insurance non-payment, isn't that chicken-and-egg? When a test costs ten times what it should? That would suggest that for each test that someone pays for, there are nine patients effectively getting it for free.
      - haldujai 13y ago
        You're assuming the cost is $200. In Canada it can be up to 6 months (from my own experience) to get a stress test booking. In the states you can do it the next week. That gets a significant premium. Compare it to buying something on eBay from Hong Kong and waiting 5-8 weeks vs paying 4x and getting it right this second from Best Buy. At the end of the day you're going to get what you need either way but it's how long you're willing to wait. $2000 is only for uninsured patients, and as has been demonstrated numerous times results in you getting shafted when it comes to pricing. A better problem to attack is reducing the amount of stress tests given, as they're often completely unnecessary. Ontario has recently decided to stop paying doctors who give unnecessary stress tests, resulting in ~5000 fewer tests given every year.
        lostlogin 13y ago
        A good thing about socialised systems (don't get me wrong, there are plenty of problems too) is that they often have more protocol homogeneity. What this helps with is that best practice gets codified and protocols written. Then a clear pathway is made for clinicians to follow, with a review system to allow for improvements. Fragmented systems with owner operators (usually sub specialists) can have other motives ($) and little to zero feedback on care quality. Large systems with set protocols helps reduce unneeded tests. Getting the money saved put back into other parts of the system however, can be.... Tricky.
namlem 13y ago
The hospitals just charge that because they can. What most people don't know is that you can often negotiate them down.
- ctdonath 13y ago
  The word "cash" works wonders. 4-10x discounts. If you're paying list price you're not even trying.
  - malandrew 13y ago
    The problem is the the overwhelming majority of Americans don't know this. I've had this conversation with many people and almost all don't know that you can get your cost discounted and that you can usually get them discounted to the Medicare/Medicaid price (which you just need to discover by matching it to CPT codes). My mom was told about a procedure that would have cost her $120k, in one question the price dropped to $30k. That's such an unfathomable discount that I think many people are ignorant because it sounds too good to be true. They end up thinking that it doesn't exist, there is some catch or that they probably don't qualify somehow.
    - Groxx 13y ago
      Fwiw, I've asked this at two locations, mostly for curiosity's sake. In both cases, the cash price was about 50% higher than what would have been paid through insurance, which was 100% not covered by my insurance. Their reason was that insurance companies usually pay a predictable amount, but people paying cash frequently stop paying and get punted to collection agencies, ending up with (significantly) less money actually going to the hospital. I'll keep asking, but it's not that clear-cut.

by jakobe 13y ago

haldujai 13y ago

People who have stress tests administered often have underlying cardiac or pulmonary disorders that can be aggravated. A not insignificant subset of people doing stress tests can enter into hypotensive shock or even cardiac arrest, the facility has to be prepared to deal with adverse effects as those reactions can be fatal.

lostlogin 13y ago
Yes - it pays to have a big defib (not one of the 'press button now' mall variety), an experienced and qualified staff member or 5 with high level CPR training, and some good cardiac event type drugs, and a load of proper monitoring gear (heart rate, BP, etc). While these things aren't especially cheap, they would pay off fairly quickly at a decent clinic, and I was involved in the purchase of most this stuff for sub $10k US recently for a clinic (but got a mall style defib as our needs are different). Staff would be the greatest cost. That said, at 2k per test, most expenses for the year would be paid of in the first week or 3 at a busy clinic surely?
- haldujai 13y ago
  $2000 isn't that ridiculous depending on the circumstances, but $75 is impossibly low with America's system. In Canada they bill ~$200 +/- 100 depending on the details. A comparable figure in the states (again factoring insurance non-payment issues and convenience factors, i.e. how soon you can get it, having facilities close by) would be reasonable at $800-$1500.
  - vacri 13y ago
    $2000 is utterly ridiculous for a stress test. I used to work as a neurology tech, mostly dealing with epilepsy. Our tests themselves could invoke seizures, and we frequently saw seizures anyway, which can be life threatening if not handled. We were a private department in a hospital - as techs, we knew enough first aid to keep the person alive and call for the crash cart. $2000 might sound reasonable if every single patient required emergency attention, but in truth, far from it. Medical tests aren't meant to bring you to the brink of death, and are generally designed to keep you safe. It's not even worth pretending that $2k 'might' be worth it; it's just not. As for covering for insurance non-payment, isn't that chicken-and-egg? When a test costs ten times what it should? That would suggest that for each test that someone pays for, there are nine patients effectively getting it for free.
    - haldujai 13y ago
      You're assuming the cost is $200. In Canada it can be up to 6 months (from my own experience) to get a stress test booking. In the states you can do it the next week. That gets a significant premium. Compare it to buying something on eBay from Hong Kong and waiting 5-8 weeks vs paying 4x and getting it right this second from Best Buy. At the end of the day you're going to get what you need either way but it's how long you're willing to wait. $2000 is only for uninsured patients, and as has been demonstrated numerous times results in you getting shafted when it comes to pricing. A better problem to attack is reducing the amount of stress tests given, as they're often completely unnecessary. Ontario has recently decided to stop paying doctors who give unnecessary stress tests, resulting in ~5000 fewer tests given every year.
      - lostlogin 13y ago
        A good thing about socialised systems (don't get me wrong, there are plenty of problems too) is that they often have more protocol homogeneity. What this helps with is that best practice gets codified and protocols written. Then a clear pathway is made for clinicians to follow, with a review system to allow for improvements. Fragmented systems with owner operators (usually sub specialists) can have other motives ($) and little to zero feedback on care quality. Large systems with set protocols helps reduce unneeded tests. Getting the money saved put back into other parts of the system however, can be.... Tricky.

namlem 13y ago

The hospitals just charge that because they can. What most people don't know is that you can often negotiate them down.

ctdonath 13y ago
The word "cash" works wonders. 4-10x discounts. If you're paying list price you're not even trying.
- malandrew 13y ago
  The problem is the the overwhelming majority of Americans don't know this. I've had this conversation with many people and almost all don't know that you can get your cost discounted and that you can usually get them discounted to the Medicare/Medicaid price (which you just need to discover by matching it to CPT codes). My mom was told about a procedure that would have cost her $120k, in one question the price dropped to $30k. That's such an unfathomable discount that I think many people are ignorant because it sounds too good to be true. They end up thinking that it doesn't exist, there is some catch or that they probably don't qualify somehow.
  - Groxx 13y ago
    Fwiw, I've asked this at two locations, mostly for curiosity's sake. In both cases, the cash price was about 50% higher than what would have been paid through insurance, which was 100% not covered by my insurance. Their reason was that insurance companies usually pay a predictable amount, but people paying cash frequently stop paying and get punted to collection agencies, ending up with (significantly) less money actually going to the hospital. I'll keep asking, but it's not that clear-cut.