It shouldn't matter these aren't he "real" prices, as so many folks have been quick to point out. But it's the starting point for what ever you think the "real" price is, and it's information that has never been easily accessible to the public until now. A̶n̶d̶ ̶i̶t̶'̶s̶,̶ ̶m̶o̶s̶t̶ ̶c̶e̶r̶t̶a̶i̶n̶l̶y̶ ̶a̶ ̶r̶e̶a̶l̶ ̶p̶r̶i̶c̶e̶ ̶i̶f̶ ̶y̶o̶u̶ ̶h̶a̶v̶e̶ ̶n̶o̶ ̶i̶n̶s̶u̶r̶a̶n̶c̶e̶.̶ Maybe not? Some are saying this isn't always the case in certain instances
We are all about markets in this country, so now it will be much easier to determine if a facilities prices are out of whack with its peers in it's local market. I don't know how much normal people will actually use this on a day to day, but I'd imagine this will open the door to some new services / products that could help regular people parse the data.
I hate that people think this is a bad thing. The comment thread in the story about this trending here a couple weeks ago was so dissapointing. It makes sense to hear the hospital executives try to downplay or spin this in a negative light. I suspect some of them are nervous about what will be found... that some shenanigans might be exposed.
I belive easy access to this data to be incredibly valuable. I think it's a win for regular people and the health of our markets. Just because it's not the price I pay after insurance doesn't make it misleading or irrelevant.
I'm afraid it is mostly irrelevant, but it is definitely the first step in the right direction. As somebody else said, it's more important to find out what real people ended up paying for a procedure after it was all said and done.
Is there a bill-sharing website to cure this information from people voluntarily? Maybe someone on HN would want to start one up? Or would people be too reluctant to share details of procedures?
This has made me wonder what the point of these high prices are if no one ever pays them. My guess has always been that it has something to do with tax write-offs for the services that they never recoup.
Aside, I hope crossed-out-text generators don't become popular on HN. Maybe a trailing "(not)" will have the same rhetorical effect, though I don't think it added anything to your post.
It triggered my browser's "Do you want to translate from Vietnamese?" pop-up.
No, data that doesn't have any coherent practical meaning is worse than no data (well, it's worth exactly the same as no data if and only if you recognize the fact that it has no coherent practical meaning and disregard it entirely.)
One of the classic bad-management failures is finding some easy to quantify it irrelevant to purpose number and optimizing around it because, hey, it may not be perfect “but data is data”.
If you don't have insurance the hospital will take what they can get.
If you have a high deductible insurance plan (mines pretty high at >$10k for my family), keep cash in your HSA so you're not put out if you max it.
Having been through several hundred thousand dollars of chargemaster charges with one of the hospitals on this list I can confidently say this info is not consumer-friendly at all.
First of all, did anyone look at the damn PDFs? Do you have any idea what a "HCHG SP EVAL MTN FLUOR SWAL 75" is or a "HCHG XR RIBS BILAT W PA CXR"? Does this really equip the typical healthcare consumer with the ability to "shop 'n save"? No. They are going to ask their health insurance provider if the hospital is in network, and the health insurance bureaucracy has the experts who pour through and negotiate all this crap.
Second, even if you had about a year of your life to educate yourself about the hundreds of myriad codes like this that are involved in various procedures and take it upon yourself to compare hospitals, this would be like comparing hotels based on their rack rate. You might get a sense for things but nobody pays that. Everything is negotiated down. Even for the uninsured who usually either get a 50%+ discount or pay whatever they can pay and kill their credit or go bankrupt. Which is not to imply in any way this is affordable for anyone, just that chargemasters aren't a super useful way to compare pricing even if you could figure it out.
Third, it's a free market fantasy that more "consumer" info will fix this system. Many patients are not in a position to comparison shop anyway. It is the epitome of a market failure.
If you want to fix this system we need Medicare For All.
Ultimately that's irrelevant, because you don't choose the services you get in a hospital, "I" do. If I come in and recommend this or that test, are you going to check the price? Of course not, because the issue is only partially hidden prices. Its also knowledge asymmetry and fear. I think most doctors only recommend tests they feel will be helpful and in my current position I have absolutely no incentive to order extra or unnecessary testing, so I try not to.
I suspect (but I guess it hasn't been proven) that moving away from fee-for-service towards Medical Home type payments will resolve a lot of this as long as quality measures are carefully monitored and decreases in quality are appropriately sanctioned.
Why are the rates of over-testing and over-diagnosis so high?
And you can’t mention a tax increase without mentioning the savings of not having to pay for private insurance.
When it comes to the U.S., particularly with anything that involves its helathy care system, the slightest event is considered a step in the right direction. Well guess what? I wholeheartedly believe that it is both sad and pathetic to consider this as a win for the people against the healthcare industry. A country as rich as the U.S. and that spends on healthcare per capita more than other countries like Canada, should not have a for profit system.
A "hospital's retail price list" is the epitome of a for profit system, those words shouldn't even be in the same sentence together.
I understand that HN crowd is probably in the top 10% of the country so advocating for the system to change probably is of no concern to us, but let's not lie to people and say things are getting better when they clearly are not.
I agree that the US system is in need of major reform, but prices, competition and markets can be an important part of a healthcare system for price constraints, innovation, mitigating corruption, etc.
As an example, consider food stamps, which helps people get food, but does so via the private market. The program would be a lot worse off if the Government decided to open grocery stores or tried to run the whole supply chain.
Perhaps a similar line of reasoning applies to healthcare?
I am always skeptical of these claims. We have a hybrid system for higher education which utilizes a competitive, private, for-profit education market, with heavy subsidies from the govt (given to the students in the form of aid). Look what it looks like, ever increasing prices.
Take our K-12 schooling system, again the same problem, somehow it works great for other racially homogenous European and Asian countries, but in America, we spend far more on public education per students, and get worse results.
So why is the belief that our healthcare system is going to look like Netherland's when our education system doesn't look like that?
https://en.wikipedia.org/wiki/Chargemaster
http://selfpaypatient.com/2014/01/03/insured-patients-can-sa...
“Hospital x is the most expensive in the area by a 15% margin on average” hurts. Ideally these comparisons start forcing hospitals to compete by sheer embarrassment.
No, they are the fake numbers they keep around as starting points so that (1) insurance can claim to have negotiated price down, and (2) they can claim the inflated numbers to be the “usual and customary charge to the general public” for purposes of government programs like Medicaid which include the usual and customary charge to the general public as one of the factors in reimbursement rates.
> They're very real if you get a bill with them on it.
A number of providers give an automatic, no negotiation needed discount from the chargemaster to uninsured patients, and most of the rest expect to allow themselves to be negotiated down. The chargemaster isn't the real price, and has no consistent relationship to it across providers.
Which is a horrible system, but it has an interesting property. The more likely someone is to complain, the more likely the system will actually work for them. To me it seems like some perverse evolved survivorship trait, for the system itself. But then I don't work in the industry, so I could be wrong about all of this.
You can see the problem. Both the hospital and the insurance company are incentivized to keep that number artificially high.
(Source: we were billed $16,666.30 for 30g of IVIG after being told it would cost around $2,000 if insurance didn’t cover it. Actual insurance rate would be $2,850 but the hospital won’t negotiate.)
Or at least that's what I gleaned from the billing side during my stint in healthcare IT. Possible that we were an outlier, or (most likely) I just misunderstood.
I bet if you logged into your health insurance portal you'd find a cost transparency tool that could give you a reasonable estimate of what a common procedure would cost.
The unfortunate truth is price doesn't really matter.
1 - Insurers have negotiated rates with providers. They don't want that information shared.
2 - There aren't that many "shoppable" procedures. Shoppable = you're going to make a conscious decision to find the best possible price. Most common were major, non-emergency surgeries like hip or knee replacements or small stuff like imaging. Once you're in the actual care "flow", its highly unlikely to tell the doctor "how much will that MRI cost me? Let me check this app to drive across town and save $20."
3 - For all the talk about consumer demand for cost transparency, Cost is low on the list when it comes to determining if/where to get care. Quality, Availability (accepting new patients, how soon can they see me), Word of Mouth (friend/family recommended), matter more. Largely because....
4 - After a certain point (i.e. once I've hit my deductible) consumers don't care about cost as long as they're in-network.
(former PM of cost transparency application)
Disclosure: I work at Amino, but I'm speaking from personal experience and not for them.
Edited to add: Plus, reality is you can't really know until you get all the bills. How are they going to code the million different things they have to choose between?
I took my son to prompt care once because he had split the webbing between two of his toes and it looked to me like it needed stitches. The doc swabbed it clean and said he couldn't stitch it. He put some superglue on it and sent us home. Paying on the way out they wanted like $450. I said no. They called the manager and told him I wanted a payment plan. I said, no I don't. I want a reasonable bill. He told them to recode it. They said they had looked for a different code and couldn't find one. They looked again. They had a coworker look again. Eventually they recoded from a laceration to a cut or something like that. Dropped the price to $120ish.
(The superglue came off in less than 24 hours.)
Help (potential) patients compare approximate total prices of different hospitals based on the patient’s conditions, diagnoses, insurance plans (or lack thereof), personal health profile, etc.
Display info as tables and charts in a user-friendly manner. Give users the option to drill down to see details. Update estimates as more information is known (e.g. after lab results come in).
Support what-if scenarios for cases which diagnoses are still unclear.
"Modern Healthcare decided to see how long it would take to present the data in a more consumer-friendly format. It took less than two hours - with a break for lunch - to create the 29 PDF files linked below."
Maybe that’s been taken down?
Always seemed like a reasonable place to start.
And if you want a sense as to what the REAL prices are, those rates are pretty damn close.
https://www.youtube.com/watch?v=CeDOQpfaUc8
On one of my non-insured years, I did get a five-digit bill like one in the video. Then some more from a bunch of other companies. It shouldn't have been legal. Especially given I couldn't exactly shop around for better prices with them all faking them.
The people getting screwed are those who pay a deductible/co-pay based on the inflated prices, ie the people who pay for health insurance.
I.e., insured patients getting service from out of network providers; otherwise, if you have insurance, and you are paying deductible or co-insurance, it's based on the insurance negotiated price, not the chargemaster price. OTOH, if you are paying a co-pay, it's a flat fee in your insurance policy and the actual (chargemaster or negotiated) price is irrelevant.
