re: Trump to force Hospitals to disclose their prices

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Dude the insurance companies negotiate the price with the hospital.

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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.

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.

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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.

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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.

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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.

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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.

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.

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If the person is truly on the verge of death

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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.'

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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.

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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.

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They can. Just like they could "divulge that data" to the public. The point is, they often don't.

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But the EO concerns the public, not doctors, from my understanding. I'm just isolating the discussion to the ramifications of the EO itself.

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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.

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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...

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But billed charges have tenuous connections to the above.

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tenuous, indeed

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But the EO concerns the public, not doctors,

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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.