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Show HN: We structured and compared hospital chargemaster prices
- aantix 13y agoLove this! If there's some unstructured data that you're having trouble taming, contact me. I have a ton of experience with Mechanhcal Turk and can give you some advice on how best to structure your HITs to extract the data that you need. jim.jones1@gmail.com
- HarryHirsch 13y agoThis is all great, but cost isn't the only metric, there is also such things as readmission rate &c. Two weeks ago or three a fellow, a physician, made the front page of HN who listed prominently listed prices for his hospital, but you had to go digging for readmission rates. That guy was on a mission, and his mission wasn't to improve public health. If his mission was that he would have listed the other important metrics. He knows all about them, he is a physician, after all. This sort of dishonesty I cannot stand.
- eruditely 13y agoIt seems you're implying malevolence and unless the other metrics substantially were worse than the other hospitals.
- HarryHirsch 13y agoNo one knows about his motives except that person himself, but it is indisputable that a public figure such as he has responsibilities to society, and he does not fulfill them.
- bdcravens 13y agoLung transplant: 0 results
- tryitnow 13y agoThis is a fascinating data problem. I noticed a lot of the price distributions are non-normally distributed (specifically with a strong positive skew for the least consistently priced procedures). You guys should have fun with this. Who will be the primary users of this information? It seems that insurers already are aware of chargemaster prices and ignore them since they're going to be bargained away. Employers seem not to care to dig into how much their insurers are paying (employers just care what premium they'll have to pay). Finally, it seems like consumers can't really use this data since they're pretty much locked into their plans anyways and will go wherever is most convenient. Now given changing consumer behavior, I could see consumers maybe using this so they have to pay less of a deductible, I could also see insurers working with consumers to steer them to the best prices - saving both the insurer and the consumer money. However, this will require overcoming consumer attachments to preferred providers (a challenge for older adults, not so much so for younger ones who often don't have a relationship with a doctor). It can be how surprising how quickly people can overcome sentimental attachments when their money is on the line though, so who knows.
- davemel37 13y agoI'm confused... This is assuming a procedure in facility A by Doctor B is a commodity and is no different than the same procedure in Facility C by Doctor D. Am I missing something?
- wffurr 13y agoFor many procedures, that's true so long as they're competently executed, which we should expect so long as the doctor is licensed to practice. To really make buying decisions for your own health care procedures, you would want user reviews in addition to prices, just like you see on every online storefront.
- bezdekt 13y agoVery cool. Does anyone pay the chargemaster price though?
- RougeFemme 13y agoI thought uninsured folks were charged the chargemaster price. They may not end up PAYING that price. . .even if they spend their entire lives trying. . .but I thought that's what uninsured folks were CHARGED.
- aguynamedben 13y agoChargemaster is kind of like (a more screwed up) MSRP when you buy a car, so not exactly, but it's an indicator of the pricing disparity for the same procedures. We've also indexed the Medicare DRGs which are a more accurate predictor. Eventually we'd like to index Paid Claims data for insurance companies, which are what actually gets paid. The prices are all over the map in general, beyond just the chargemaster prices.
- cosmie 13y agoChargemaster is also a brilliant and evil tax deduction[1]. [1] http://www.nytimes.com/2013/05/17/business/bayonne-medical-center-has-highest-us-billing-rates.html?hp&_r=1&pagewanted=all& http://www.nytimes.com/2013/05/17/business/bayonne-medical-c...
- jparker165 13y agoYah, the joke I've heard from industry folks is that "only the Sultan of Brunei would pay those prices." But since many actual prices are determined as a percentage of the chargemaster, the provider with the lowest chargemaster price is likely to have the lowest actual price. Directionally correct data is better than no data? no?
- ars 13y agoNo, no one pays that. And I don't think the chargemaster price is even correlated with the final price, so it's not even useful as a relative measure. I wish it was a real price though - maybe this site could push hospitals that way. But I doubt it because the reason hospitals are able to afford Medicare prices is only because they overcharge the rest, and the prices are made opaque specifically so that that people do not complain about that. The only way to make transparent healthcare prices is to raise medicare prices so that everyone pays the same, but that'll never happen. So what happens is that insured people pay an extra premium to help out the rest. Airlines do the same thing, and they too have very convoluted hard to understand prices.
- atldev 13y agoBackground on the chargemaster story that broke in Time Magazine. (So glad it was covered by The Daily Show or I would have missed it): http://healthland.time.com/2013/02/20/bitter-pill-inside-times-cover-story-on-medical-bills/ http://healthland.time.com/2013/02/20/bitter-pill-inside-tim...
- aguynamedben 13y agoHere's the Jon Stewart segment: http://www.thedailyshow.com/watch/mon-may-13-2013/bi-annual-competency-round-up http://www.thedailyshow.com/watch/mon-may-13-2013/bi-annual-... Some other links to more info are at the footer of the page. There was an interesting US Senate hearing with Steven Brill, the author of the Time article.
- GauntletWizard 13y agoThis is the kind of data that is needed for true transparency, and true medical reform. Prices will be gouged so long as you can't compare; Realistically, this still has a long way to go (Because I'm certain that a lot of these differences are in part due to one procedure being billed as many different codes under the current US regulatory mess), but it's a good step up from what we've had available in the past.
- cookiecaper 13y agoThe only thing that's going to matter in effectively reforming medical cost structures in the U.S. is getting a critical mass of people who are shut out from medicine due to the insurance scam. While there are presently some people who are in a bad position, it's not enough people to really mount a meaningful united front. Sure, people are upset, but not enough people are upset in the right way to really make policymakers fear for their careers and/or lives. Huge swaths of "money" in the medical industry are the result of paper pushing, pure and simple. No one is spending their own money, or even really "real" money: the doctor's bill will say something outrageous for the cash price, because they know the insurers will demand a large reduction, and even though they write "$40,000" for something, they don't actually expect anyone to pay that directly. They expect you to either call and get a "cash payment discount", i.e., something close to what they charge insurance companies (which is still really high, because insurance companies aren't spending "real" money either), or to use your insurer to "pay" the bill. Remove the lecherous middle-men who do nothing but shuffle numbers around and we can start making progress on medical pricing. This is not the ONLY cause of high costs, but it is easily the largest and most perverse problem point, because this type of billing completely destroys all conventional rules of supply and demand. Interestingly, the Affordable Care Act does the opposite of this, and strengthens the lecherous middle-men to the point that it will be illegal not to give them money (the government will forcibly take the money from you in the form of a "tax penalty" if you do not voluntary sign up for "medical insurance").
- 001sky 13y agoThis is a generalized problem with insurance, tho. Ie, if you had a likely expense, you would plan for it (house, college, etc). You buy insurance precisely because you don't think you'll need it. So, the people that need to use it are always going to be a small group. The people that don't have it, another group. The people getting screwed (on the sharp end) are the subset of those where there is overlap. This will always be a small number (by math). That being said, for everyone is paying into the system but its more death by thousand cuts. As long as pricing is opaque and uncorrleated with out-of-pocket marginal payments, there will be a problem. The cleaner solution is simply to remove the facade of pricing a-la-carte services. The problem there, is two fold: (1) how to control the inevitable buracracy with a huge budget making life or death decisions; and (2) how to incentivise research and science/product development without the cash cow of monopoly pricing (patents are useless if selling is illegal). While these problems seem to be solvable, they are daunting and not simple. In a world where the NSA is spying on every electronic communication over the internet, perhaps even more so. Ie, a world where privacy and trust is being undermined by those seeking to entrench their own power. Its harder poltically to delegate more responsibility to the "government".
- deleted 13y ago[deleted]
- patmcguire 13y agoIsn't the chargemaster price mostly unrelated to anything? http://runningahospital.blogspot.com/2013/05/useless-noise-from-cms.html http://runningahospital.blogspot.com/2013/05/useless-noise-f...
- hkiely 13y agoNo one pays chargemaster prices. The reason hospitals set the prices so high is because they are the starting point for negotiations with networks and insurance companies. Even consumers without insurance typically don't pay chargemaster prices as hospitals normally have cash pay discounts. As payers begin to contract with ACO's, I think we'll likely see a shift to a more standard shape bell curve if reform is working.
- jmcgough 13y agoReally cool! One thing - the google map always sets California as the state, even when I look at hospitals in other states.
- chime 13y agoOne suggestion: The dropdown for "Find a Hospital" needs to show the location too. I tried searching for "St. Anthony's" near my town and multiples ones from all over the country showed up. I put in my zip code but it did not filter the results. I have no idea how to look for St. Anthony's near 33708 or not. I don't know if it is St. Anthony's Medical Center or Health Center or Hospital. But there's only one St. Anthony's here in St. Petersburg, FL.
- gknoy 13y agoWhen I entered a zip code, it showed a map w/ nearby hospitals. Perhaps they have no data from yours?
- babby 13y agoSome tweaks to the design would help! At the top of the page, the search boxes are mis-aligned to the text above them. Fix that. They could also take up more horizontal space, or simply be aligned better. Add an extra ~3-10px of horizontal padding to table cells (td's) Table headings should be text-align: center except for the longest field (hospital). Also, vertical-align: middle on table headings. Link color on the tables could also be darker. Add left-margin/padding on the (?) question mark icon at the top right of fields. Font size on the search drop downs could be bigger. May want to try the font "Open Sans", too, on the tables. Add a hover effect for all links and buttons. It's kind of nuts that you could overlook that. Add a focus effect for all inputs. Also make input font color brighter, and on focus, make font color darker. On the "worst hospitals" table, the percentages could use a + sign before them like "+97%".
- NKCSS 13y agoVery cool. I wished this would be done for hospitals in .NL as well.
- donquichotte 13y agoGreat idea! There seems to be a minor flaw in the data though, the Healdsburg District Hospital appears do be doing many procedures for 1$. http://pricemed.org/hospitals/healdsburg-district-hospital http://pricemed.org/hospitals/healdsburg-district-hospital
- pc86 13y agoIt looks like the sorting is off. It's saying that Cedars-Sinai is the worst priced hospital for the linked procedures, but at "only" a 99% marked over the average $1,300 even though there are many in the $3-5.2k range.
- ljoshua 13y agoI love it, thanks for sharing. Where did you get the original data from? (I thought chargemasters were relatively guarded secrets?)
- jparker165 13y agoraw California chargemaster data was in excel files at this gov't website: http://www.oshpd.ca.gov/chargemaster http://www.oshpd.ca.gov/chargemaster outside of California, the data from a release by Medicare: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient.html http://www.cms.gov/Research-Statistics-Data-and-Systems/Stat...