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re: Trump to force Hospitals to disclose their prices
Posted on 6/21/19 at 1:08 pm to Lsujacket66
Posted on 6/21/19 at 1:08 pm to Lsujacket66
There is never a reason to not have price transparency.
Posted on 6/21/19 at 1:34 pm to Codythetiger
My story is my friend got hurt in a biking accident. He wasn't bleeding badly, but his face was pretty cut up tovwhere you could almost see bone and required probably 30 stitches. But it happened on a Saturday night, and there were lots of other people getting more attention, so we were sitting there for almost 4 hours. Eventually I had the idea they could give him something for the pain. They gave him 1 10mg pill of percocet. The cost? $130 dollars.
Posted on 6/21/19 at 1:57 pm to pizzatiger
quote:The hospital sets prices. It then negotiates discounts to various insurance companies off those set prices. In the case of obamacare insurance companies, those negotiations are increasingly with one insurance provider.
Dude the insurance companies negotiate the price with the hospital.
Price disclosure could be based on nondiscounted fee, average negotiated fee, or suboptimally it could be formulated/extrapolated per facility based on CMS billing data. Any or all of those, and could be basis for reasonable approximations..
What good would it do?
Well, for example if one hospital runs a series of Family Medicine Clinics predominantly using MDs while the another hospital system employs Nurse Practitioners or rotating providers for the same or higher charge, a patient might want to know that in advance. Especially if there is copay exposure.
If one facility outsources path or lab results to an uncovered provider while another does not, charge differentials could be significant. Patients should be apprised of that cost in advance.
But a significant benefit would arise in the fact most hospitals are run so inefficiently that the individuals who are actually generating charges have no clue as to what is expensive and what is not. Ask a surgeon the cost differential between two fairly interchangeable sutures --- often he'll have no clue. Ask an RN cost differential between two IV cannulas -- same thing, no clue. Ask an administrator the cost of not having enough clean up crews for an OR, they might well respond "the fewer the better". . . . ie not a clue. Nor in many (most) cases do facilities have good insight into innumerable cost sinks. Much of that would become apparent and therefore addressable with price transparency.
From an insurance end, if two facilities charge significantly differently, yet insurance does not pass those potential savings to patients, folks should know that.
Forcing price determination and direct interfacility numbers publication would change the dynamic.
If you need personification here, look no further than our own illustrious BamaAtl. The poor guy picks up a check twice a month without so much as a hint of a clue as to what his employer actually charges for his services or what actual costs he is imparting.
Bottomline, our current third payer structure places considerable distance between care and patient charge. As a result inefficiencies go unrecognized, innovative cost-reduction opportunities are lost, and the system hemorrhages money.
Posted on 6/21/19 at 2:07 pm to DarthRebel
quote:
Whoever decided this should be fired. Complete waste of money.
It's the size of an entire city block. Do you have any idea how many flowers and hedges there are on a campus that big?
Posted on 6/21/19 at 2:08 pm to NC_Tigah
quote:
Well, for example if one hospital runs a series of Family Medicine Clinics predominantly using MDs while the another hospital system employs Nurse Practitioners or rotating providers for the same or higher charge, a patient might want to know that in advance. Especially if there is copay exposure.
If one facility outsources path or lab results to an uncovered provider while another does not, charge differentials could be significant. Patients should be apprised of that cost in advance.
I support transparency. It's certainly better than the alternative. It's just that the complexity of interaction between patient, doctor, and insurance means that full disclosure is going to have limited effect.
quote:
But a significant benefit would arise in the fact most hospitals are run so inefficiently that the individuals who are actually generating charges have no clue as to what is expensive and what is not. Ask a surgeon the cost differential between two fairly interchangeable sutures --- often he'll have no clue. Ask an RN cost differential between two IV cannulas -- same thing, no clue. Ask an administrator the cost of not having enough clean up crews for an OR, they might well respond "the fewer the better". . . . ie not a clue. Nor in many (most) cases do facilities have good insight into innumerable cost sinks. Much of that would become apparent and therefore addressable with price transparency.
I'm not really sure what you're getting at here. This EO is about disclosure to the public. Maybe physicians don't understand the costs, but their employers can certainly divulge that data. Nothing is changing in that scenario.
This post was edited on 6/21/19 at 2:09 pm
Posted on 6/21/19 at 2:09 pm to NC_Tigah
quote:Great 30-word summary of a big driver of prices today.
Bottomline, our current third payer structure places considerable distance between care and patient charge. As a result inefficiencies go unrecognized, innovative cost-reduction opportunities are lost, and the system hemorrhages money.
Posted on 6/21/19 at 2:10 pm to Lsujacket66
I have had this discussion with friends who are doctors. They explain that the markups are to subsidize the people who are getting free care. Lots of folks with no insurance use the ER as their doctor's office.
If you really wanted to bring prices down then change the laws so that hospitals could reject non paying ER patients. They could just point them to the nearest vacant lot to go die. Harsh? Perhaps.
If you really wanted to bring prices down then change the laws so that hospitals could reject non paying ER patients. They could just point them to the nearest vacant lot to go die. Harsh? Perhaps.
Posted on 6/21/19 at 2:14 pm to Zach
quote:
If you really wanted to bring prices down then change the laws so that hospitals could reject non paying ER patients. They could just point them to the nearest vacant lot to go die. Harsh? Perhaps.
If the person is truly on the verge of death, you don't have time to figure out whether he/she has insurance, especially if he/she is not conscious
'Scuse me sir, I see you are bleeding profusely from the head, can I see some ID and your insurance card?
This post was edited on 6/21/19 at 2:15 pm
Posted on 6/21/19 at 2:19 pm to pizzatiger
quote:
If the person is truly on the verge of death
That's the tiny minority of ER patients. My wife works in the ER. They get:
'The hair on my head hurts.'
'My baby won't go to sleep.'
'I need some of them pills you got for pain.'
Posted on 6/21/19 at 2:26 pm to Zach
quote:
That's the tiny minority of ER patients. My wife works in the ER. They get:
'The hair on my head hurts.'
'My baby won't go to sleep.'
'I need some of them pills you got for pain.'
I know, but in your other post you said the patients could go die in the parking lot. So I was assuming you were talking about people on the verge of death and not people with headaches.
Posted on 6/21/19 at 2:28 pm to Barneyrb
quote:
$40 for Tylenol, actual charge from my mother's bill before her death. Medicare paid it but that is a problem.
Another guy touched on it; as he said: Medicare didn't pay nearly $40 for the drug.
There is the cost
There is the charge
Then there is the reimbursement. It differs from insurance to insurance. Medicare may pay $4 where BCBS may pay $6 and Humana may pay $2. These are fictional numbers and don't represent what I think Tylenol is worth. That said, there is the "hidden" cost of the inpatient pharmacist, nurse, and the supplies used to deliver the medicine - it's quite a bloated system, but these levels of redundancy are why hospitals are as safe as they are, which is overall pretty good. Errors happen. So there's an additional risk management team that has every error reported to it, reviews it, and takes action as needed (IE firing nurses or pharmacists that have higher than acceptable error rates or egregious errors).
The cash payer, though, gets a $40 bill. The cash payer is also a tremendously small portion of who pays hospital bills. Worth noting, they simply need to call and negotiate the "cash price" (much like the CMS and Blue Cross and Humana prices). They also happily work on payment plans and (from the cases I'm familiar with) don't charge interest on it.
The bill is bizarre. But it is a made up number, and no one should ever pay it. Publishing the prices goes a long way, but the system as it is would probably be much better tolerated if people understood it better. This will only help, I should hope.
Posted on 6/21/19 at 2:29 pm to pizzatiger
quote:
I know, but in your other post you said the patients could go die in the parking lot. So I was assuming you were talking about people on the verge of death and not people with headaches.
Well, that was assuming you don't want to go through the task of defining where to draw the line. There are over 1,000 insurance codes for ER treatments. If we just banned everyone who couldn't pay it would make people think more carefully about their health insurance coverage.
Posted on 6/21/19 at 2:29 pm to pizzatiger
quote:They can. Just like they could "divulge that data" to the public. The point is, they often don't.
their employers can certainly divulge that data
Posted on 6/21/19 at 2:32 pm to NC_Tigah
quote:
They can. Just like they could "divulge that data" to the public. The point is, they often don't.
But the EO concerns the public, not doctors, from my understanding. I'm just isolating the discussion to the ramifications of the EO itself.
Posted on 6/21/19 at 2:43 pm to Lsujacket66
This is great.
I’m sure they’ll try to game the system.
But if I’m having gall bladder surgery, I should be able to know that my out of pocket costs at St Luke’s will be $750 and at Missouri Baptist it will be $1050 and then make my mind up based on the quality of the hospital.
I’m sure they’ll try to game the system.
But if I’m having gall bladder surgery, I should be able to know that my out of pocket costs at St Luke’s will be $750 and at Missouri Baptist it will be $1050 and then make my mind up based on the quality of the hospital.
Posted on 6/21/19 at 2:50 pm to Tiguar
quote:
Incredibly ignorant post and mindset.
You pay markup on food at a restaurant too. You are paying for the service.
You have to pay the salary of the person who stocks the saline. You have to pay the salary of the RN who puts the IV in you and administers the saline. You have to pay the salary of the doctor who ordered the saline. You also have to pay the electric bill. You have to pay housekeeping. Et cetera.
Doctors and RN salary is generally higher than server and cook salary, so your markup is higher.
This is an incredibly ignorant post...
Facility fee reimbursements and DRGs factor in those things. Marking saline up $50 has very little to do with labor costs associated with delivering the saline and everything to do with a 3rd party payor system that doesn't force patients to be consumers...like a restaurant menu does...
Posted on 6/21/19 at 2:54 pm to YipSkiddlyDooo
quote:
Facility fee reimbursements and DRGs factor in those things.
But billed charges have tenuous connections to the above.
Posted on 6/21/19 at 3:00 pm to the808bass
quote:
But billed charges have tenuous connections to the above.
tenuous, indeed
Posted on 6/21/19 at 3:04 pm to Lsujacket66
There are already competitive pricing battles between some facilities and some doctors. It's good for the market.
Posted on 6/21/19 at 3:06 pm to pizzatiger
quote:If you drew a Venn Diagram of "doctors" and "public" you'd be looking at concentric circles. If the public gets access, so will doctors.
But the EO concerns the public, not doctors,
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